Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OS9656 | FL |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | OS9656 | FL |
NPI | 1235148461 |
---|---|
Provider Name | Luis Ricardo Cortes |
First Address | Fort Myers, FL 33908-3600 |
Second Address | Fort Myers, FL 33908-3600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 20/02/2020 |