MEDICARE: DR. DALE C BETTERTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD201025	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114112364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALE C BETTERTON M.D.

Provider Business Mailing Address
First Line	:	800 UNIVERSITY DR
Second Line	:
City	:	DODGE CITY
State	:	KS
Zip	:	67801-2750
Country	:	US
Telephone Number	:	865-207-9011
Fax Number	:

Provider Business Practice Location Address
First Line	:	5501 READ BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-3103
Country	:	US
Telephone Number	:	504-245-7951
Fax Number	:	504-245-7935

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	09/11/2007

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