# DR. BENJAMIN BRYCE BETTERIDGE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1225007388
- **Gender:** Man
- **Credential:** MD, CAQ SPORTS MEDIC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | 2948311205 | UT | — |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | MD00043643 | WA | — |
| 207PS0010X | Sports Medicine (Emergency Medicine) Physician | 294831-1205 | UT | — |
| 207PS0010X | Sports Medicine (Emergency Medicine) Physician | 43643 | WA | Yes |
| 207PS0010X | Sports Medicine (Emergency Medicine) Physician | MD00043643 | WA | — |
| 207PT0002X | Medical Toxicology (Emergency Medicine) Physician | 43643 | WA | — |

## Other

- **Enumeration date:** 03/14/2006
- **Last updated:** 07/31/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 942854058788-D6149 | — | UT |