Provider Demographics
NPI:1831300532
Name:HARCOURT, ROGER LEE (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:LEE
Last Name:HARCOURT
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 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:888-987-1151
Mailing Address - Fax:
Practice Address - Street 1:4430 14TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1425
Practice Address - Country:US
Practice Address - Phone:941-297-2123
Practice Address - Fax:941-297-2210
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAJ002516L111NR0400X
PAMD072508L207R00000X
FLME95059207R00000X
PADC-002516-L111NX0800X
NC2008 00631207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280176100Medicaid
FLP00737666OtherRAILROAD MEDICARE
PA1836709Medicaid
FLP00737666OtherRAILROAD MEDICARE
FLAI323VMedicare UPIN