Provider Demographics
NPI:1558672303
Name:BETTERLY, DANIEL RUSSEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RUSSEL
Last Name:BETTERLY
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 1:1525 NW 62ND ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2439
Mailing Address - Country:US
Mailing Address - Phone:844-248-4320
Mailing Address - Fax:
Practice Address - Street 1:3501 JOHNSON STREET
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5487
Practice Address - Country:US
Practice Address - Phone:954-265-5339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-27
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT197676390200000X
NY390200000X
FLME159943207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program