Provider Demographics
NPI:1124227988
Name:WILJON W BELTRE MD PA
Entity Type:Organization
Organization Name:WILJON W BELTRE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILJON
Authorized Official - Middle Name:W
Authorized Official - Last Name:BELTRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-830-6868
Mailing Address - Street 1:106 BOSTON AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4712
Mailing Address - Country:US
Mailing Address - Phone:407-830-6868
Mailing Address - Fax:407-830-7801
Practice Address - Street 1:106 BOSTON AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4731
Practice Address - Country:US
Practice Address - Phone:407-830-6868
Practice Address - Fax:407-830-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76567208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256082800Medicaid
FL256082800Medicaid
FLK2026Medicare PIN