Provider Demographics
NPI:1578644282
Name:MANASTER, BETTY JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:JEAN
Last Name:MANASTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-5258
Mailing Address - Country:US
Mailing Address - Phone:303-494-9911
Mailing Address - Fax:
Practice Address - Street 1:4200 E NINTH AVE
Practice Address - Street 2:BOX A030
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80262-0001
Practice Address - Country:US
Practice Address - Phone:303-372-6136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR000000038105204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine