Individual
EDGAR BETANCOURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
333 PINE RIDGE BLVD, WAUSAU, WI 54401-4120
(715) 847-2130
Mailing address
2800 WESTHILL DR, WAUSAU, WI 54401-3771
(715) 847-0075
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
43096
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34061700
—
WI
Enumeration date
01/25/2006
Last updated
10/18/2023
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