Provider Demographics
NPI:1427157262
Name:MAGDALIN-BETTS, DAWN H (MD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:H
Last Name:MAGDALIN-BETTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 OAK FARM LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4046
Mailing Address - Country:US
Mailing Address - Phone:707-579-5406
Mailing Address - Fax:
Practice Address - Street 1:3250 OAK FARM LN
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4046
Practice Address - Country:US
Practice Address - Phone:707-579-5406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48766207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A487660Medicaid
CA00F523980Medicare ID - Type Unspecified
CA00A487660Medicaid