Provider Demographics
NPI:1184835738
Name:BETANCOURT, LUIS FRANCISCO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:FRANCISCO
Last Name:BETANCOURT
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:PO BOX 549
Mailing Address - Street 2:VILLAS DE PIEDRAS BLANCAS
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-0549
Mailing Address - Country:US
Mailing Address - Phone:787-669-5567
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 111 KM 2.9 AVE LOS PATRIOTAS
Practice Address - Street 2:LARES MEDICAL CENTER
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669
Practice Address - Country:US
Practice Address - Phone:787-897-1444
Practice Address - Fax:787-897-1463
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9223208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20049OtherSSS
PR0081917Medicare ID - Type Unspecified