Provider Demographics
NPI:1659349058
Name:BETCHER, RUSSELL ANDERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:ANDERSON
Last Name:BETCHER
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 1:1422 OLD WEISGARBER RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1293
Mailing Address - Country:US
Mailing Address - Phone:865-558-4400
Mailing Address - Fax:865-558-4471
Practice Address - Street 1:1422 OLD WEISGARBER RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2674
Practice Address - Country:US
Practice Address - Phone:865-558-4400
Practice Address - Fax:865-558-4471
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD28975207X00000X
TN28975207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5113561OtherAETNA
TN100011418OtherTENNCARE
TN3091851OtherBLUE CROSS BLUE SHIELD
TNTN0162OtherJOHN DEERE HEALTHCARE
TNTN0113OtherJOHN DEERE HEALTHCARE
TN200033047OtherRAILROAD MEDICARE
TNTN0143OtherJOHN DEERE HEALTHCARE
7100117160OtherKY MEDICAID
TN3813217Medicaid
TN5113561OtherAETNA
TNTN0162OtherJOHN DEERE HEALTHCARE
TN103I202839Medicare PIN
TNTN0143OtherJOHN DEERE HEALTHCARE
TN3813217Medicaid
TN38132140Medicare PIN