MEDICARE: DR. LESLIE LUDWIG CORTES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	F3861	TX

General Provider Information

NPI Number	:	1548319916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE LUDWIG CORTES M.D.

Provider Business Mailing Address
First Line	:	2108 PARAMOUNT AVE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-3936
Country	:	US
Telephone Number	:	512-349-5573
Fax Number	:

Provider Business Practice Location Address
First Line	:	12401 RESEARCH BLVD STE 220
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-2314
Country	:	US
Telephone Number	:	512-349-5573
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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