Provider Demographics
NPI:1376861849
Name:BETTIN, CLAYTON CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:CHARLES
Last Name:BETTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1400 S GERMANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2205
Mailing Address - Country:US
Mailing Address - Phone:901-759-3100
Mailing Address - Fax:901-759-5416
Practice Address - Street 1:1211 UNION AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6638
Practice Address - Country:US
Practice Address - Phone:901-759-3100
Practice Address - Fax:901-759-5416
Is Sole Proprietor?:No
Enumeration Date:2010-05-09
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54304207X00000X, 207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS100212871Medicaid
MS05035265Medicaid
TNQ025470Medicaid
AR216986001Medicaid