Provider Demographics
NPI:1871815845
Name:CLAUDE W. BETTY, M.D., P.A.
Entity Type:Organization
Organization Name:CLAUDE W. BETTY, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-435-3653
Mailing Address - Street 1:3020 GARRETT DR.
Mailing Address - Street 2:
Mailing Address - City:PERRYTON
Mailing Address - State:TX
Mailing Address - Zip Code:79070-5322
Mailing Address - Country:US
Mailing Address - Phone:806-435-3653
Mailing Address - Fax:806-435-2327
Practice Address - Street 1:3020 GARRETT DR.
Practice Address - Street 2:
Practice Address - City:PERRYTON
Practice Address - State:TX
Practice Address - Zip Code:79070-5322
Practice Address - Country:US
Practice Address - Phone:806-435-3653
Practice Address - Fax:806-435-2327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1548208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1102923-01Medicaid
00H111Medicare PIN
TX1102923-01Medicaid