Healthcare Provider Details

I. General information

NPI: 1811985831
Provider Name (Legal Business Name): BILL R MCCOURTNEY II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 DEQUEEN ST
MENA AR
71953-4132
US

IV. Provider business mailing address

1210 DEQUEEN ST
MENA AR
71953-4132
US

V. Phone/Fax

Practice location:
  • Phone: 479-243-0303
  • Fax: 479-243-0320
Mailing address:
  • Phone: 479-243-0303
  • Fax: 479-243-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE3174
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: