Provider Demographics
NPI:1265518666
Name:BETTS, JAY GORDON (DO)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:GORDON
Last Name:BETTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10365 SE SUNNYSIDE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5741
Mailing Address - Country:US
Mailing Address - Phone:503-698-2300
Mailing Address - Fax:503-698-2308
Practice Address - Street 1:10365 SE SUNNYSIDE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5741
Practice Address - Country:US
Practice Address - Phone:503-698-2300
Practice Address - Fax:503-698-2308
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORDO07540207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR067231Medicaid
ORR114358Medicare ID - Type Unspecified
OR067231Medicaid