Provider Demographics
NPI:1700849833
Name:BETTING, SUSAN P (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:P
Last Name:BETTING
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:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:701-323-8300
Mailing Address - Fax:701-323-8305
Practice Address - Street 1:3318 N 14TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-1614
Practice Address - Country:US
Practice Address - Phone:701-323-8300
Practice Address - Fax:701-323-8305
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND7324207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND18646Medicaid
ND18646Medicaid
ND21450Medicare PIN