Provider Demographics
NPI:1558333211
Name:BETTERTON, GILLIAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:GILLIAN
Middle Name:M
Last Name:BETTERTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 COBURG RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7479
Mailing Address - Country:US
Mailing Address - Phone:541-324-8616
Mailing Address - Fax:541-686-4814
Practice Address - Street 1:10 COBURG RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7479
Practice Address - Country:US
Practice Address - Phone:541-324-8616
Practice Address - Fax:541-686-4814
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19808207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR079442Medicaid
ORR016WFBFRJMedicare PIN
OR079442Medicaid
G25102Medicare UPIN
R016WFBFRJMedicare PIN