Provider Demographics
NPI:1194834275
Name:CORTINA, JOHN JEFFREY (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JEFFREY
Last Name:CORTINA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:JEFFERY
Other - Last Name:CORTINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1021 W OAKLAND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2192
Mailing Address - Country:US
Mailing Address - Phone:423-302-6565
Mailing Address - Fax:
Practice Address - Street 1:1350 HICKORY ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3224
Practice Address - Country:US
Practice Address - Phone:321-434-4225
Practice Address - Fax:321-434-4247
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO2865207RP1001X
PA0S008622L207RP1001X
KY03675207RP1001X
VA0102206432207RP1001X
NC200800053207RP1001X
GA63410207RP1001X
FLOS13998207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0326OtherGROUP MEDICARE NUMBER
610283400OtherBLACK LUNG
PA94946OtherGEISINGER
P00233040OtherMETRAHEALTH RAILROAD MEDI
NC5908296Medicaid
FLT3367OtherMEDICARE HF
NC01960OtherGROUP BCBS
FL110487900Medicaid
NC8901960OtherGROUP MEDICAID
NC1467405431OtherGROUP NPI
PA251424OtherUPMC
NC560989277OtherTAX ID
PA0016237640014Medicaid
PA00662229OtherBLUE SHIELD
NC148V3OtherBCBS
NC0326OtherGROUP MEDICARE NUMBER