Provider Demographics
NPI:1841361557
Name:DENNIS A CORTES MD PA
Entity type:Organization
Organization Name:DENNIS A CORTES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:ALFREDO
Authorized Official - Last Name:CORTES
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:954-435-6211
Mailing Address - Street 1:12600 PEMBROKE RD STE 206
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2544
Mailing Address - Country:US
Mailing Address - Phone:954-435-6211
Mailing Address - Fax:954-435-6212
Practice Address - Street 1:12600 PEMBROKE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2544
Practice Address - Country:US
Practice Address - Phone:954-435-6211
Practice Address - Fax:954-435-6212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66763207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251171100Medicaid
FL545152001OtherDME
FL251171100Medicaid
F43657Medicare UPIN