Provider Demographics
NPI:1851553481
Name:BETENSKY, BRIAN P (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:P
Last Name:BETENSKY
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 1:1950 ARLINGTON ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3513
Mailing Address - Country:US
Mailing Address - Phone:941-917-4250
Mailing Address - Fax:
Practice Address - Street 1:1950 ARLINGTON ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3513
Practice Address - Country:US
Practice Address - Phone:941-917-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD440691207R00000X
FLME127467207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME127467OtherMEDICAL LICENSE
FL017346700Medicaid
FLIP347ZMedicare PIN