Individual
ALLEN WILLIAM CORTEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1701 4TH ST, STE 200, SANTA ROSA, CA 95404-3601
(707) 579-2100
(707) 523-0616
Mailing address
3536 MENDOCINO AVE, STE 200, SANTA ROSA, CA 95403-3634
(707) 575-6049
(707) 523-0616
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G76718
CA
2086S0127X
Trauma Surgery Physician
G76718
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G767180
BS OF CALIFORNIA
CA
05
—
00G767180
—
CA
05
—
00G767181
—
CA
01
—
P00469229
RR MEDICARE
CA
Enumeration date
05/10/2006
Last updated
02/07/2012
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