Provider Demographics
NPI:1841238342
Name:BETTASSO, BERNARD F (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:F
Last Name:BETTASSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-347-8318
Mailing Address - Fax:417-347-8316
Practice Address - Street 1:3202 MCINTOSH CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3646
Practice Address - Country:US
Practice Address - Phone:417-347-8318
Practice Address - Fax:417-347-8316
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR3F30207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A11621Medicare UPIN