Provider Demographics
NPI:1033435318
Name:BETTIS, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BETTIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 NW 88TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-2700
Mailing Address - Country:US
Mailing Address - Phone:319-356-2864
Mailing Address - Fax:319-356-0363
Practice Address - Street 1:5151 NW 88TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-2700
Practice Address - Country:US
Practice Address - Phone:319-356-2864
Practice Address - Fax:319-356-0363
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019017101207W00000X
KS04-43912207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology