Provider Demographics
NPI:1114112364
Name:BETTERTON, DALE C (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:C
Last Name:BETTERTON
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 1:800 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2750
Mailing Address - Country:US
Mailing Address - Phone:865-207-9011
Mailing Address - Fax:
Practice Address - Street 1:5501 READ BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-3103
Practice Address - Country:US
Practice Address - Phone:504-245-7951
Practice Address - Fax:504-245-7935
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD201025207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA52917Medicaid