Provider Demographics
NPI:1891972733
Name:BETTMAN, JEROME W JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:W
Last Name:BETTMAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:W
Other - Last Name:BETTMAN
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 70125
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87197-0125
Mailing Address - Country:US
Mailing Address - Phone:505-888-7082
Mailing Address - Fax:505-888-7082
Practice Address - Street 1:2727 SAN PEDRO DRIVE, N.E.
Practice Address - Street 2:SUITE 115
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3364
Practice Address - Country:US
Practice Address - Phone:505-888-7082
Practice Address - Fax:505-888-7082
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM69103207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology