Provider Demographics
NPI:1164510756
Name:COURT, SERGIO B (MD)
Entity type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:B
Last Name:COURT
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 1:25 N 14TH ST
Mailing Address - Street 2:SUITE 870
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-6204
Mailing Address - Country:US
Mailing Address - Phone:408-294-1967
Mailing Address - Fax:408-294-3407
Practice Address - Street 1:25 N 14TH ST
Practice Address - Street 2:SUITE 870
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-6204
Practice Address - Country:US
Practice Address - Phone:408-294-1967
Practice Address - Fax:408-294-3407
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA031130174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB99306Medicare UPIN