Healthcare Provider Details

I. General information

NPI: 1134290414
Provider Name (Legal Business Name): LUIS EDGARDO KORTRIGHT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 273356
TAMPA FL
33688-3356
US

IV. Provider business mailing address

PO BOX 273356
TAMPA FL
33688-3356
US

V. Phone/Fax

Practice location:
  • Phone: 813-871-5200
  • Fax: 813-871-2423
Mailing address:
  • Phone: 813-368-5522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberME 50767
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: