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General NPI Number Information
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NPI Number | 1306135603
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Entity Type | Organization
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Legal Business Name | DONALD L COURSEY MD MEDICAL CORPORATION
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Dates
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Enumeration Date | 04/07/2011
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Last Update Date | 04/07/2011
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Provider Practice Location Address
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Address Line | 1165 S DORA ST STE C2
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City | UKIAH
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State | CA
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Zip | 95482-6353
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Country | US
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Telephone | 707-462-8855
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Fax |
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Provider Business Mailing Address
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Address Line | 1165 S DORA ST STE C2
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City | UKIAH
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State | CA
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Zip | 95482-6353
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Country | US
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Telephone | 707-462-8855
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DONALD L COURSEY
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Credential | M.D.
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Telephone | 707-462-8855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G16584
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License Number State | CA
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