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General NPI Number Information
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NPI Number | 1659387512
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Entity Type | Individual
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Provider Name | DAVID BETAT M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 02/27/2015
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Provider Practice Location Address
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Address Line | 801 11TH ST
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City | LAKEPORT
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State | CA
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Zip | 95453-4100
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Country | US
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Telephone | 707-413-3259
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Fax | 707-413-3260
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Provider Business Mailing Address
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Address Line | 2255 CEDAR HILL WAY
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City | LAKEPORT
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State | CA
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Zip | 95453-9762
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Country | US
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Telephone | 707-262-1401
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Fax | 707-262-1401
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G57755
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License Number State | CA
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