Provider Demographics
NPI:1821165895
Name:COURTNEY, RICHARD GILMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GILMAN
Last Name:COURTNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3054
Mailing Address - Country:US
Mailing Address - Phone:863-299-1155
Mailing Address - Fax:863-299-1177
Practice Address - Street 1:529 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3054
Practice Address - Country:US
Practice Address - Phone:863-299-1155
Practice Address - Fax:863-299-1177
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME774282085R0202X
TNMD475662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1524453Medicaid
TN4300084OtherBCBS OF TN
TN103I306336Medicare PIN