Provider Demographics
NPI:1790543205
Name:BETANCOURT BAUER, WILLIAM JAMES
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
Last Name:BETANCOURT BAUER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE NUEVA 173 BARRIADA ISRAEL
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-1720
Mailing Address - Country:US
Mailing Address - Phone:787-461-6304
Mailing Address - Fax:
Practice Address - Street 1:CENTRO MEDICO DE PUERTO RICO BARRIO MONACILLOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935-0001
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program