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General NPI Number Information
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NPI Number | 1487200549
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Entity Type | Individual
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Provider Name | JASON ALEXANDER CORTES
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Gender | Male
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Dates
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Enumeration Date | 08/14/2019
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 602 SW 38TH ST
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City | LAWTON
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State | OK
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Zip | 73505-6912
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Country | US
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Telephone | 580-248-5780
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Fax |
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Provider Business Mailing Address
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Address Line | 2717 NW DENVER AVE
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City | LAWTON
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State | OK
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Zip | 73505-3942
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Country | US
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Telephone | 580-647-3762
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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