Provider Demographics
NPI:1306814025
Name:CORTEZ, STEPHEN JAMES (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JAMES
Last Name:CORTEZ
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 1:1890 LPGA BLVD
Mailing Address - Street 2:STE. 160
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-7130
Mailing Address - Country:US
Mailing Address - Phone:386-252-4701
Mailing Address - Fax:386-253-9410
Practice Address - Street 1:1890 LPGA BLVD
Practice Address - Street 2:STE. 160
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-7130
Practice Address - Country:US
Practice Address - Phone:386-252-4701
Practice Address - Fax:386-253-9410
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67305207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376786800Medicaid
00551OtherBC BS
4615664OtherAETNA
00551OtherBC BS
F70888Medicare UPIN