Healthcare Provider Details

I. General information

NPI: 1912116997
Provider Name (Legal Business Name): LUIS ALBERTO CORTES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 W SAMPLE RD
POMPANO BEACH FL
33064-3542
US

IV. Provider business mailing address

5 W SAMPLE RD
POMPANO BEACH FL
33064-3542
US

V. Phone/Fax

Practice location:
  • Phone: 954-782-1700
  • Fax: 954-782-7490
Mailing address:
  • Phone: 954-782-1700
  • Fax: 954-782-7490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number125-045422
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME101262
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: