Healthcare Provider Details

I. General information

NPI: 1710988233
Provider Name (Legal Business Name): JAYSON G CORTEZ DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 SW 89TH ST
OKLAHOMA CITY OK
73159-6307
US

IV. Provider business mailing address

1522 SW 89TH ST
OKLAHOMA CITY OK
73159-6307
US

V. Phone/Fax

Practice location:
  • Phone: 405-691-6694
  • Fax: 405-691-6404
Mailing address:
  • Phone: 405-691-6694
  • Fax: 405-691-6404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number222
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPD307R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: