Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 35977 | SC |
N | 207QA0505X | Family Doctor - Adult Medicine | 4301116648 | MI |
Y | 208D00000X | General Practice Physician | 4301116648 | MI |
NPI | 1235578428 |
---|---|
Provider Name | Dr. Christopher Randolph Betts |
First Address | Covina, CA 91723-1906 |
Second Address | Covina, CA 91723-1906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2013 |
Last Update Date | 19/02/2019 |