Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | ME 50767 | FL |
NPI | 1134290414 |
---|---|
Provider Name | Luis Edgardo Kortright |
First Address | Tampa, FL 33688-3356 |
Second Address | Tampa, FL 33688-3356 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 17/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
048333800 | (05) | FL |
05703 | INSURANCE (01) | FL |
D51400 | (02) | FL |
ME 50767 | LICENSE (01) | FL |