Provider Demographics
NPI:1821358490
Name:BETTS, BRENT S (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:S
Last Name:BETTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:999 N CURTIS RD STE 205
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1316
Mailing Address - Country:US
Mailing Address - Phone:702-408-4664
Mailing Address - Fax:
Practice Address - Street 1:999 N CURTIS RD STE 205
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1316
Practice Address - Country:US
Practice Address - Phone:702-408-4664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9697340-1205207W00000X
IDM-13650207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology