Healthcare Provider Details

I. General information

NPI: 1811293053
Provider Name (Legal Business Name): JONATHAN COURTNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2011
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3313 W HILLSBORO BLVD SUITE 202
DEERFIELD BEACH FL
33442-9423
US

IV. Provider business mailing address

3313 W HILLSBORO BLVD SUITE 202
DEERFIELD BEACH FL
33442-9423
US

V. Phone/Fax

Practice location:
  • Phone: 954-571-9500
  • Fax:
Mailing address:
  • Phone: 954-571-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number261371
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberME122073
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: