Provider Demographics
NPI:1720004401
Name:CORTES, JESUS CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:CARLOS
Last Name:CORTES
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 1:646 W PALM DR
Mailing Address - Street 2:
Mailing Address - City:FLORIDA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33034-3208
Mailing Address - Country:US
Mailing Address - Phone:305-242-0883
Mailing Address - Fax:305-242-9523
Practice Address - Street 1:1401 E 4TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-3504
Practice Address - Country:US
Practice Address - Phone:305-888-9000
Practice Address - Fax:305-242-9523
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061857207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF47187Medicare UPIN