Healthcare Provider Details

I. General information

NPI: 1982687901
Provider Name (Legal Business Name): LUIS FRANCISCO RODRIGUEZ-BETANCOURT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 01/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 GRISWOLD ST
WALTON NY
13856-1338
US

IV. Provider business mailing address

2 TITUS PL
WALTON NY
13856-1455
US

V. Phone/Fax

Practice location:
  • Phone: 607-865-6867
  • Fax: 607-865-5446
Mailing address:
  • Phone: 607-865-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1790641
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: