Provider Demographics
NPI:1134290414
Name:KORTRIGHT, LUIS EDGARDO (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:EDGARDO
Last Name:KORTRIGHT
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:PO BOX 273356
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33688-3356
Mailing Address - Country:US
Mailing Address - Phone:813-368-5522
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 273356
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33688-3356
Practice Address - Country:US
Practice Address - Phone:813-871-5200
Practice Address - Fax:813-871-2423
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 50767207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048333800Medicaid
FLME 50767OtherLICENSE
FL05703OtherINSURANCE
FL05703Medicare ID - Type Unspecified
FL048333800Medicaid