Provider Demographics
NPI:1811985831
Name:MCCOURTNEY, BILL R II (MD)
Entity type:Individual
Prefix:
First Name:BILL
Middle Name:R
Last Name:MCCOURTNEY
Suffix:II
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 1:1210 DEQUEEN ST
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-4132
Mailing Address - Country:US
Mailing Address - Phone:479-243-0303
Mailing Address - Fax:479-243-0320
Practice Address - Street 1:1210 DEQUEEN ST
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-4132
Practice Address - Country:US
Practice Address - Phone:479-243-0303
Practice Address - Fax:479-243-0320
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3174207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5M011OtherBCBS
AR145539001Medicaid
AR5M011OtherBCBS
AR145539001Medicaid