NPIMap

Individual provider Active NPI

Wilberto G. Cortes

  • Plastic Surgery Physician
  • Conroe, TX
National Provider Identifier
1174695514
Registry record updated Oct 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
M8612 Issued in TX
Practice address
2105 W Davis St Ste B
Conroe, TX 77304-2062
Phone
(936) 760-2696
Fax
(936) 756-2662
NPI assigned
Nov 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X M8612 TX Primary

Addresses

Primary practice location

2105 W Davis St Ste B
Conroe, TX 77304-2062

Mailing address

2105 W Davis St Ste B
Conroe, TX 77304-2062
Phone (936) 760-2696

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Independent Physicians Network PLLC Past Accepting new patients
Rejuvenus Aesthetics Plastic Surgery Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286928000000",
    "number": "1174695514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 W DAVIS ST STE B",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773042062",
            "telephone_number": "936-760-2696",
            "fax_number": "936-756-2662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 W DAVIS ST STE B",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773042062",
            "telephone_number": "936-760-2696",
            "fax_number": "936-756-2662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORTES",
        "first_name": "WILBERTO",
        "middle_name": "G.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2010-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "TX",
            "license": "M8612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conroe, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.