Provider Demographics
NPI:1497834964
Name:BETSON, LANCE HALL (DO)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:HALL
Last Name:BETSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:320 SUPERIOR AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-6140
Mailing Address - Country:US
Mailing Address - Phone:949-548-3441
Mailing Address - Fax:949-548-2074
Practice Address - Street 1:320 SUPERIOR AVE STE 280
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-6140
Practice Address - Country:US
Practice Address - Phone:949-548-3441
Practice Address - Fax:949-548-2074
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7341207VG0400X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Single Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G70794Medicare UPIN
G70794Medicare UPIN