Provider Demographics
NPI:1467644336
Name:LUIS R CORTES DO PA
Entity Type:Organization
Organization Name:LUIS R CORTES DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:RICARDO
Authorized Official - Last Name:CORTES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-358-9900
Mailing Address - Street 1:255 SE 14TH ST
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1852
Mailing Address - Country:US
Mailing Address - Phone:954-358-9900
Mailing Address - Fax:954-358-9901
Practice Address - Street 1:255 SE 14TH ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1852
Practice Address - Country:US
Practice Address - Phone:954-358-9900
Practice Address - Fax:954-358-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9656261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH276Medicare PIN