Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 28961 | AL |
NPI | 1104917764 |
---|---|
Provider Name | John Andrew Harcourt |
First Address | Daphne, AL 36526-4298 |
Second Address | Daphne, AL 36526-4298 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 25/03/2016 |