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

Code values:
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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