Provider Demographics
NPI:1841256021
Name:RAWLS LLOYD, BETTYE JO E (MD)
Entity type:Individual
Prefix:MRS
First Name:BETTYE JO
Middle Name:E
Last Name:RAWLS LLOYD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:BETTYE JO
Other - Middle Name:ELVAN
Other - Last Name:RAWLS LLOYD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11455 N MERIDIAN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1624
Mailing Address - Country:US
Mailing Address - Phone:317-846-4223
Mailing Address - Fax:317-846-6063
Practice Address - Street 1:1801 N SENATE BLVD
Practice Address - Street 2:SUITE 620
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1228
Practice Address - Country:US
Practice Address - Phone:317-926-6699
Practice Address - Fax:317-921-1723
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032373A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100068150Medicaid
IN318010EMedicare PIN