Provider Demographics
NPI:1528803533
Name:AUBOURG, BETHLY (MD)
Entity type:Individual
Prefix:
First Name:BETHLY
Middle Name:
Last Name:AUBOURG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13210 SW 14TH PL
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-5721
Mailing Address - Country:US
Mailing Address - Phone:954-404-0967
Mailing Address - Fax:
Practice Address - Street 1:13210 SW 14TH PL
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325-5721
Practice Address - Country:US
Practice Address - Phone:954-404-0967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program