Provider Demographics
NPI:1770729816
Name:CORTES, RAFAEL A (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:A
Last Name:CORTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 BELFORT RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6004
Mailing Address - Country:US
Mailing Address - Phone:904-398-7205
Mailing Address - Fax:
Practice Address - Street 1:100 WHETSTONE PL
Practice Address - Street 2:SUITE 105
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5774
Practice Address - Country:US
Practice Address - Phone:904-829-9557
Practice Address - Fax:904-829-9125
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90959207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001047300Medicaid
GA003159216AOtherGEORGIA MEDICAID
FL001047300Medicaid