Provider Demographics
NPI:1952678310
Name:WENDELL J. COURTNEY, M.D.,P.A.
Entity Type:Organization
Organization Name:WENDELL J. COURTNEY, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:COURTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-787-1001
Mailing Address - Street 1:601 E DIXIE AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7302
Mailing Address - Country:US
Mailing Address - Phone:352-787-1001
Mailing Address - Fax:
Practice Address - Street 1:601 E DIXIE AVE STE 301
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7302
Practice Address - Country:US
Practice Address - Phone:352-787-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50296207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty