Provider Demographics
NPI:1710988233
Name:CORTEZ, JAYSON G (DPM)
Entity Type:Individual
Prefix:
First Name:JAYSON
Middle Name:G
Last Name:CORTEZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 SW 89TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6307
Mailing Address - Country:US
Mailing Address - Phone:405-691-6694
Mailing Address - Fax:405-691-6404
Practice Address - Street 1:1522 SW 89TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6307
Practice Address - Country:US
Practice Address - Phone:405-691-6694
Practice Address - Fax:405-691-6404
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK222213ES0131X
LAPD307R213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1S4035OtherMEDICARE
OK200995970AMedicaid
LA1105121Medicaid