Provider Demographics
NPI:1730123258
Name:COURTNEY, PHILLIP E (CRNA)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:E
Last Name:COURTNEY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:PHIL
Other - Middle Name:E
Other - Last Name:COURTNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:2409 SENDERO AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-8452
Mailing Address - Country:US
Mailing Address - Phone:956-358-0619
Mailing Address - Fax:866-292-3522
Practice Address - Street 1:3333 N FOSTER MALDONADO BLVD
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-5148
Practice Address - Country:US
Practice Address - Phone:830-773-5321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248055207L00000X
TXAP110499367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P19669Medicare UPIN