Provider Demographics
NPI:1003844648
Name:BETTING, GARY ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ROBERT
Last Name:BETTING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:515 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501
Mailing Address - Country:US
Mailing Address - Phone:701-751-9500
Mailing Address - Fax:701-751-9508
Practice Address - Street 1:515 E BROADWAY
Practice Address - Street 2:CENTER FOR FAMILY MEDICINE
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501
Practice Address - Country:US
Practice Address - Phone:701-751-9500
Practice Address - Fax:701-751-9508
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND6970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND18112Medicaid
ND12432OtherBCBS
ND12432OtherBCBS
F83293Medicare UPIN