Provider Demographics
NPI:1659571263
Name:BETKER, CHARLES ROBERT II (LMP)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ROBERT
Last Name:BETKER
Suffix:II
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 112TH ST SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-5283
Mailing Address - Country:US
Mailing Address - Phone:425-355-5000
Mailing Address - Fax:
Practice Address - Street 1:711 112TH ST SE
Practice Address - Street 2:SUITE C
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-5283
Practice Address - Country:US
Practice Address - Phone:425-355-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-21
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019202174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist