Provider Demographics
NPI:1912196486
Name:CORPUS NEPHROLOGY NETWORK PLLC
Entity Type:Organization
Organization Name:CORPUS NEPHROLOGY NETWORK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:L
Authorized Official - Last Name:CORTESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-884-9244
Mailing Address - Street 1:4022 OCEAN DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1222
Mailing Address - Country:US
Mailing Address - Phone:361-884-9244
Mailing Address - Fax:361-884-9284
Practice Address - Street 1:1521 S STAPLES ST
Practice Address - Street 2:SUITE 603
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3150
Practice Address - Country:US
Practice Address - Phone:361-884-9244
Practice Address - Fax:361-884-9284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0427207RN0300X
207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF0427OtherTX LICENSE