Individual
DR. JENNESS DONIPHAN COURTNEY III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1801 FAIRFIELD AVE, SUITE 411, SHREVEPORT, LA 71101-4443
(318) 424-4224
(318) 424-4044
Mailing address
1801 FAIRFIELD AVE, SUITE 411, SHREVEPORT, LA 71101-4443
(318) 424-4224
(318) 424-4044
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
023053
LA
208100000X
Physical Medicine & Rehabilitation Physician
E1524
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
078793901
TX MCD
TX
05
—
1494135
—
LA
Enumeration date
08/26/2005
Last updated
06/28/2010
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