Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 6970 | ND |
NPI | 1003844648 |
---|---|
Provider Name | Gary Robert Betting |
First Address | Bismarck, ND 58501 |
Second Address | Bismarck, ND 58501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 18/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12432 | BCBS (01) | ND |
18112 | (05) | ND |
F83293 | (02) |