Provider Demographics
NPI:1790968972
Name:STUART A. COURTNEY DPM
Entity Type:Organization
Organization Name:STUART A. COURTNEY DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:COURTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-458-2228
Mailing Address - Street 1:1250 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:SUITE 1005A
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4636
Mailing Address - Country:US
Mailing Address - Phone:954-458-2228
Mailing Address - Fax:954-458-2530
Practice Address - Street 1:1250 E HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE 1005A
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4636
Practice Address - Country:US
Practice Address - Phone:954-458-2228
Practice Address - Fax:954-458-2530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO745213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1318120001Medicare NSC