MEDICARE: DR. RAY VALADEZ CORTEZ 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	208D00000X	General Practice Physician	J4059	TX
2	208000000X	Pediatrics Physician	J4059	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5428691	OTHER	TX	AETNA
2	74-2946869	OTHER	TX	TID
3	8AJ410	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1710901541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAY VALADEZ CORTEZ M.D.

Provider Business Mailing Address
First Line	:	102 BABCOCK RD STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-3952
Country	:	US
Telephone Number	:	210-572-1430
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 BABCOCK RD STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-3952
Country	:	US
Telephone Number	:	210-572-1430
Fax Number	:	210-572-1434

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	12/01/2021

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