Healthcare Provider Details

I. General information

NPI: 1730159302
Provider Name (Legal Business Name): DONALD EARLE COURTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9790 SR 20 WEST
YOUNGSTOWN FL
32466
US

IV. Provider business mailing address

9790 SR 20 WEST
YOUNGSTOWN FL
32466
US

V. Phone/Fax

Practice location:
  • Phone: 209-736-4850
  • Fax: 209-736-9660
Mailing address:
  • Phone: 209-736-4850
  • Fax: 209-736-9660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME 0065988
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: