Provider Demographics
NPI:1730220674
Name:DELACOURT, LINDA JEAN (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JEAN
Last Name:DELACOURT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 13TH AVE S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-6421
Mailing Address - Country:US
Mailing Address - Phone:312-479-2130
Mailing Address - Fax:
Practice Address - Street 1:2021 KINGSLEY AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5174
Practice Address - Country:US
Practice Address - Phone:904-276-5400
Practice Address - Fax:904-276-5430
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92583207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology