Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 43430 | TN |
Y | 208000000X | Pediatrician | 43430 | TN |
NPI | 1609086214 |
---|---|
Provider Name | Dr. Marc Vincent Courts |
First Address | Loudon, TN 37774-1323 |
Second Address | Loudon, TN 37774-1323 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 29/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1503975 | (05) | TN |