Provider Demographics
NPI:1528129228
Name:BETANCOURT, ALEJANDRO J (MD)
Entity type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:J
Last Name: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 1:2224 S. 77 SUNSHINE STRIP
Mailing Address - Street 2:SUITE 96 #PMB 202
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8305
Mailing Address - Country:US
Mailing Address - Phone:956-425-3706
Mailing Address - Fax:956-425-6731
Practice Address - Street 1:597 W. SESAME DR.
Practice Address - Street 2:SUITE D.
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8364
Practice Address - Country:US
Practice Address - Phone:956-425-3706
Practice Address - Fax:956-425-6731
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2139204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150406002Medicaid
TXMDL2139OtherWORKER'S COMPENSATION NO
TX00000010JUOtherBCBS IND #
TXH55185Medicare UPIN
TX150406002Medicaid