Provider Demographics
NPI:1902955990
Name:DOWTY, BETTY JEAN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:JEAN
Last Name:DOWTY
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:JEAN
Other - Last Name:DOWTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PHD
Mailing Address - Street 1:548 LAPALCO BLVD
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7305
Mailing Address - Country:US
Mailing Address - Phone:504-304-6089
Mailing Address - Fax:504-304-6388
Practice Address - Street 1:548 LAPALCO BLVD
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7305
Practice Address - Country:US
Practice Address - Phone:504-304-6089
Practice Address - Fax:504-304-6388
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD022600207R00000X
LAMD.022600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05488393Medicaid
LA1483923Medicaid
LA5A4017061Medicare PIN
MS05488393Medicaid
LA5CJ20Medicare ID - Type Unspecified