Healthcare Provider Details

I. General information

NPI: 1548319916
Provider Name (Legal Business Name): LESLIE LUDWIG CORTES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12401 RESEARCH BLVD STE 220
AUSTIN TX
78759-2314
US

IV. Provider business mailing address

2108 PARAMOUNT AVE
AUSTIN TX
78704-3936
US

V. Phone/Fax

Practice location:
  • Phone: 512-349-5573
  • Fax:
Mailing address:
  • Phone: 512-349-5573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberF3861
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: