Provider Demographics
NPI:1164475497
Name:BELTRE, WILJON W (MD)
Entity Type:Individual
Prefix:DR
First Name:WILJON
Middle Name:W
Last Name:BELTRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 BOSTON AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4731
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:STE 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
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76567208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256082800Medicaid
FL44357YMedicare ID - Type Unspecified
FL256082800Medicaid
FL44357XMedicare PIN