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NPI Code Detail

MEDICARE: DR. DANIEL RUSSEL BETTERLY MD

MEDICARE: DR. DANIEL RUSSEL BETTERLY MD
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
1390200000XStudent in an Organized Health Care Education/Training ProgramMT197676PA
2390200000XStudent in an Organized Health Care Education/Training ProgramNY
3207L00000XAnesthesiology PhysicianME159943FL

Other Identifiers

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

General Provider Information

NPI Number : 1558672303
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANIEL RUSSEL BETTERLY MD
Provider Business Mailing Address
First Line : 1525 NW 62ND ST
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33309-2439
Country : US
Telephone Number : 844-248-4320
Fax Number :
Provider Business Practice Location Address
First Line : 3501 JOHNSON STREET
Second Line :
City : HOLLYWOOD
State : FL
Zip : 33021-5487
Country : US
Telephone Number : 954-265-5339
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2010
Last Update Date : 04/03/2024

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