Provider Demographics
NPI:1780010934
Name:SAPPINGTON, BETHANY RENAE (MD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:RENAE
Last Name:SAPPINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:RENAE
Other - Last Name:CHANDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:ST LUKES CLINIC - GENERAL SURGERY
Mailing Address - Street 2:775 POLE LINE RD W, SUITE 212
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301
Mailing Address - Country:US
Mailing Address - Phone:208-814-8400
Mailing Address - Fax:208-734-3045
Practice Address - Street 1:ST LUKES CLINIC - GENERAL SURGERY
Practice Address - Street 2:775 POLE LINE RD W, SUITE 212
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301
Practice Address - Country:US
Practice Address - Phone:208-814-8400
Practice Address - Fax:208-734-3045
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-15827208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery