Healthcare Provider Details

I. General information

NPI: 1912199357
Provider Name (Legal Business Name): ALEJANDRO J. BETANCOURT, M.D., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 W SESAME DR SUITE D
HARLINGEN TX
78550-8364
US

IV. Provider business mailing address

597 W SESAME DR SUITE D
HARLINGEN TX
78550-8364
US

V. Phone/Fax

Practice location:
  • Phone: 956-425-3706
  • Fax: 956-425-6731
Mailing address:
  • Phone: 956-425-3706
  • Fax: 956-425-6731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberL2139
License Number StateTX

VIII. Authorized Official

Name: ALEJANDRO J. BETANCOURT
Title or Position: MEDICAL DOCTOR/SELF
Credential: M.D.
Phone: 956-425-3706