Provider Demographics
NPI:1811657554
Name:FERRER-BETHENCOURT, ANTHONY (DHA, MPH, BSHPE, EMT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:FERRER-BETHENCOURT
Suffix:
Gender:M
Credentials:DHA, MPH, BSHPE, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 164TH ST SE # B12-336
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6385
Mailing Address - Country:US
Mailing Address - Phone:800-670-2393
Mailing Address - Fax:866-583-4970
Practice Address - Street 1:11882 POSSESSION WAY
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5174
Practice Address - Country:US
Practice Address - Phone:206-274-6614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2002065006207PE0004X
261Q00000X, 261QE0002X, 261QP0904X, 261QR1300X, 261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health