Provider Demographics
NPI:1194738641
Name:BELTRAN, JULIO (PA)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:
Last Name:BELTRAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 24001
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33307-4001
Mailing Address - Country:US
Mailing Address - Phone:954-267-8777
Mailing Address - Fax:954-772-7801
Practice Address - Street 1:6550 N FEDERAL HWY
Practice Address - Street 2:SUITE 512
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1404
Practice Address - Country:US
Practice Address - Phone:954-267-8777
Practice Address - Fax:954-772-7801
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9100708363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291319400Medicaid
FL291319400Medicaid