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General NPI Number Information
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NPI Number | 1891972733
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Entity Type | Individual
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Provider Name | JEROME W BETTMAN JR. MD
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Gender | Male
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Dates
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Enumeration Date | 01/23/2008
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Last Update Date | 12/17/2010
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Provider Practice Location Address
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Address Line | 2727 SAN PEDRO DRIVE, N.E. SUITE 115
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-3364
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Country | US
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Telephone | 505-888-7082
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Fax | 505-888-7082
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Provider Business Mailing Address
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Address Line | P.O. BOX 70125
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City | ALBUQUERQUE
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State | NM
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Zip | 87197-0125
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Country | US
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Telephone | 505-888-7082
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Fax | 505-888-7082
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 69103
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License Number State | NM
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