Provider Demographics
NPI:1508853268
Name:CORTEZ, GREGORIO III (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORIO
Middle Name:
Last Name:CORTEZ
Suffix:III
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 1:7201 RANCH ROAD 2222
Mailing Address - Street 2:APT 2322
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-3208
Mailing Address - Country:US
Mailing Address - Phone:512-347-2726
Mailing Address - Fax:855-261-1378
Practice Address - Street 1:1250 S CAPITAL OF TEXAS HWY
Practice Address - Street 2:BUILDING 1, SUITE 360
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6446
Practice Address - Country:US
Practice Address - Phone:512-347-2726
Practice Address - Fax:885-261-1378
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3863207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX036240202Medicaid
OTH000Medicare UPIN