Provider Demographics
NPI:1538278213
Name:MCCOURTIE, ANTON STUART (MD)
Entity type:Individual
Prefix:DR
First Name:ANTON
Middle Name:STUART
Last Name:MCCOURTIE
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 1:529 JASMINE ST
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-9589
Mailing Address - Country:US
Mailing Address - Phone:509-826-1600
Mailing Address - Fax:509-826-3633
Practice Address - Street 1:529 JASMINE ST
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9589
Practice Address - Country:US
Practice Address - Phone:509-826-1600
Practice Address - Fax:509-826-3633
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML20008639208600000X
WAMD60227253208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0297859OtherL&I
WA1538278213Medicaid
WAP01082422OtherRR MEDICARE
WA0297859OtherL&I
WAG8920004Medicare PIN