Provider Demographics
NPI:1669445862
Name:CORTORREAL, PROSPERO ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:PROSPERO
Middle Name:ANTONIO
Last Name:CORTORREAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4759 US HWY 19
Mailing Address - Street 2:NEW PORT RICHEY PRIMARY CARE CENTER
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4945
Mailing Address - Country:US
Mailing Address - Phone:727-841-8772
Mailing Address - Fax:727-842-4727
Practice Address - Street 1:4759 US HWY 19
Practice Address - Street 2:NEW PORT RICHEY PRIMARY CARE CENTER
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4945
Practice Address - Country:US
Practice Address - Phone:727-841-8772
Practice Address - Fax:727-842-4727
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2011-09-29
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Provider Licenses
StateLicense IDTaxonomies
FLME73702207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256219700Medicaid
FL256219700Medicaid
G00350Medicare UPIN