Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 54304 | TN |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 54304 | TN |
NPI | 1376861849 |
---|---|
Provider Name | Dr. Clayton Charles Bettin |
First Address | Germantown, TN 38138-2205 |
Second Address | Memphis, TN 38104-6638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2010 |
Last Update Date | 01/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05035265 | (05) | MS |
216986001 | (05) | AR |
Q025470 | (05) | TN |