Provider Demographics
NPI:1700804325
Name:BETTINGER, BRADLEY I (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:I
Last Name:BETTINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4022 CESAR CHAVEZ ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-1919
Mailing Address - Country:US
Mailing Address - Phone:415-550-1731
Mailing Address - Fax:
Practice Address - Street 1:4022 CESAR CHAVEZ ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-1919
Practice Address - Country:US
Practice Address - Phone:415-550-1731
Practice Address - Fax:415-647-1766
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG187802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG18780OtherPHYSICIAN & SURGEON CERT