Healthcare Provider Details

I. General information

NPI: 1154523397
Provider Name (Legal Business Name): MANUEL F BETANCOURT-RAMIREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 N KENTUCKY AVE
WINTER PARK FL
32789-4741
US

IV. Provider business mailing address

1110 N KENTUCKY AVE
WINTER PARK FL
32789-4741
US

V. Phone/Fax

Practice location:
  • Phone: 407-539-2766
  • Fax: 407-539-2786
Mailing address:
  • Phone: 74-539-2766
  • Fax: 407-539-2786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME105206
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME105206
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: