Individual
DR. BRUCE A. BETHANCOURT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4400 N 32ND ST, SUITE 140, PHOENIX, AZ 85018-3953
(602) 254-4424
(602) 254-6036
Mailing address
4400 N 32ND ST, SUITE 140, PHOENIX, AZ 85018-3953
(602) 254-4424
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD12752
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
232562
—
AZ
Enumeration date
08/16/2005
Last updated
02/19/2008
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