Provider Demographics
NPI:1982687901
Name:RODRIGUEZ-BETANCOURT, LUIS FRANCISCO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:FRANCISCO
Last Name:RODRIGUEZ-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 1:2 TITUS PL
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856-1455
Mailing Address - Country:US
Mailing Address - Phone:607-865-2400
Mailing Address - Fax:
Practice Address - Street 1:42 GRISWOLD ST
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856-1338
Practice Address - Country:US
Practice Address - Phone:607-865-6867
Practice Address - Fax:607-865-5446
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1790641207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01498806Medicaid
NY01498806Medicaid
F91590Medicare UPIN