DR. DAVID E. PROVENCHER M.D.
Allergy and Immunology
Plant City, Florida
Provider NPI: 1326098120
Provider Information:DR. DAVID E. PROVENCHER M.D.
Practice Location:
106 SOUTHERN OAK DRIVE PLANT CITY, FL 33563 US
Tel: 813-752-8595 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
N | 2080P0201X | Physicians Pediatrics Pediatric Allergy & Immunology | FL | ME81615 |
Y | 207K00000X | Physicians Allergy & Immunology | FL | ME81615 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
262145201 | FL | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
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