Provider Demographics
NPI:1922004647
Name:BETANCES, PEDRO A (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:A
Last Name:BETANCES
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 1:8900 SE 165TH MULBERRY LN
Mailing Address - Street 2:NORTH FLORIDA / SOUTH GEORGIA VETERANS HEALTH SYSTEM
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-5884
Mailing Address - Country:US
Mailing Address - Phone:352-674-5053
Mailing Address - Fax:352-674-5001
Practice Address - Street 1:8900 SE 165TH MULBERRY LN
Practice Address - Street 2:NORTH FLORIDA / SOUTH GEORGIA VETERANS HEALTH SYSTEM
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5884
Practice Address - Country:US
Practice Address - Phone:352-674-5053
Practice Address - Fax:352-674-5001
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14292208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0021161Medicare ID - Type Unspecified
PRH99074Medicare UPIN