Provider Demographics
NPI:1518916683
Name:CORTES-MORAN, RAFAEL A (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:A
Last Name:CORTES-MORAN
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 1:1514 JEFFERSON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:441 WALL BLVD.
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7723
Practice Address - Country:US
Practice Address - Phone:504-371-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA201171207Q00000X
PR12936207Q00000X
LAMD.201171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1505960Medicaid
MS05435004Medicaid
LA4M4787061Medicare PIN
H36009Medicare UPIN
PR0020463Medicare ID - Type Unspecified
LA4M478Medicare PIN