Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | L2139 | TX |
NPI | 1528129228 |
---|---|
Provider Name | Dr. Alejandro J Betancourt |
First Address | Harlingen, TX 78550-8305 |
Second Address | Harlingen, TX 78550-8364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 18/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00000010JU | BCBS IND # (01) | TX |
150406002 | (05) | TX |
H55185 | (02) | TX |
MDL2139 | WORKER'S COMPENSATION NO (01) | TX |