Provider Demographics
NPI:1871164947
Name:JAYSON G CORTEZ LLC
Entity type:Organization
Organization Name:JAYSON G CORTEZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYSON
Authorized Official - Middle Name:G
Authorized Official - Last Name:CORTEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:337-424-5601
Mailing Address - Street 1:1522 SW 89TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6307
Mailing Address - Country:US
Mailing Address - Phone:405-691-6694
Mailing Address - Fax:405-691-6404
Practice Address - Street 1:1522 SW 89TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6307
Practice Address - Country:US
Practice Address - Phone:405-691-6694
Practice Address - Fax:405-691-6404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty