Provider Demographics
NPI:1912199357
Name:ALEJANDRO J. BETANCOURT, M.D., PA
Entity Type:Organization
Organization Name:ALEJANDRO J. BETANCOURT, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR/SELF
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:J
Authorized Official - Last Name:BETANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-425-3706
Mailing Address - Street 1:597 W SESAME DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8364
Mailing Address - Country:US
Mailing Address - Phone:956-425-3706
Mailing Address - Fax:956-425-6731
Practice Address - Street 1:597 W SESAME DR
Practice Address - Street 2:SUITE D
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8364
Practice Address - Country:US
Practice Address - Phone:956-425-3706
Practice Address - Fax:956-425-6731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2139173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0010JUOtherBCBS
TX154192201Medicaid
TXMDL2139OtherWC
TX1528129228OtherNPI
0010JUOtherBCBS
TX1528129228OtherNPI