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NPI Code Detail

MEDICARE: DR. ANTONIO MIGUEL BETANCOURT M.D.

MEDICARE: DR. ANTONIO MIGUEL BETANCOURT M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianME36555FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164473286
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANTONIO MIGUEL BETANCOURT M.D.
Provider Business Mailing Address
First Line : 1720 S GADSDEN ST
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32301-5506
Country : US
Telephone Number : 850-576-4073
Fax Number :
Provider Business Practice Location Address
First Line : 1720 S GADSDEN ST
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32301-5506
Country : US
Telephone Number : 850-576-4073
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2006
Last Update Date : 01/28/2013

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