Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 27403 | SC |
NPI | 1033180039 |
---|---|
Provider Name | Norman Bettle |
First Address | Port Royal, SC 29935-2029 |
Second Address | Port Royal, SC 29935-2029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2006 |
Last Update Date | 22/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
274036 | (05) | SC |
GP1188 | (05) | SC |