Provider Demographics
NPI:1346201076
Name:BETTINGER, PAUL THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:THOMAS
Last Name:BETTINGER
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:PO BOX 50750
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82605-0750
Mailing Address - Country:US
Mailing Address - Phone:307-265-8300
Mailing Address - Fax:307-265-8313
Practice Address - Street 1:419 S WASHINGTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2951
Practice Address - Country:US
Practice Address - Phone:307-265-8300
Practice Address - Fax:307-265-8313
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6343A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY20365Medicare ID - Type Unspecified
WYF67189Medicare UPIN
WYW20365Medicare PIN