Healthcare Provider Details

I. General information

NPI: 1104917764
Provider Name (Legal Business Name): JOHN ANDREW HARCOURT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 DAPHNE AVE
DAPHNE AL
36526-4298
US

IV. Provider business mailing address

1505 DAPHNE AVE
DAPHNE AL
36526-4298
US

V. Phone/Fax

Practice location:
  • Phone: 251-625-2663
  • Fax: 251-625-3198
Mailing address:
  • Phone: 251-625-2663
  • Fax: 251-625-3198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number28961
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: