Doctor Name: | MR. DONALD DENNIS BETTIS |
NPI Number: | 1003152976 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | BC-HIS |
License Number: | 1966 |
Business Practice Address: | 1221 W Spresser St Taylorville, IL - 625681714 |
Business Phone Number: | 2178245210 |
Business Fax Number: | 2178245211 |
Mailing Address: | 1221 W Spresser St, TAYLORVILLE |
State: | IL |
Postal Code: | 625681714 |
Phone Number: | 2178245210 |
Fax Number: | 2178245211 |
NPI Enumeration Date: | 12/21/2012 |
NPI Last Update Date: | 12/21/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 246Z00000X |
License Number: | 1966 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
Taxonomy Classification: | Specialist/Technologist, Other |
Taxonomy Specialization: | |
Taxonomy Definition: | General classification identifying individuals trained on specific equipment and technical procedures in one of a collection of miscellaneous healthcare disciplines. |