Healthcare Provider Details

I. General information

NPI: 1225371677
Provider Name (Legal Business Name): BORIS BETANCOURT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BORIS BETANCOURT MD

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 STIRLING RD STE 108
HOLLYWOOD FL
33024-8011
US

IV. Provider business mailing address

9700 STIRLING RD STE 108
HOLLYWOOD FL
33024-8011
US

V. Phone/Fax

Practice location:
  • Phone: 954-686-5575
  • Fax: 954-743-0514
Mailing address:
  • Phone: 954-686-5575
  • Fax: 954-743-0514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME152984
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: