1902955990 NPI number — DR. BETTY JEAN DOWTY MD, PHD

Table of content: DR. BETTY JEAN DOWTY MD, PHD (NPI 1902955990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902955990 NPI number — DR. BETTY JEAN DOWTY MD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOWTY
Provider First Name:
BETTY
Provider Middle Name:
JEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOWTY
Provider Other First Name:
BETTY
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1902955990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
548 LAPALCO BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRETNA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70056-7305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-304-6089
Provider Business Mailing Address Fax Number:
504-304-6388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
548 LAPALCO BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRETNA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70056-7305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-304-6089
Provider Business Practice Location Address Fax Number:
504-304-6388
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD022600 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD.022600 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 05488393 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1483923 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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