# DR. DAVID E. PROVENCHER JR.

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1326098120
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207K00000X | Allergy & Immunology Physician | ME81615 | FL | Yes |
| 2080P0201X | Pediatric Allergy/Immunology Physician | ME81615 | FL | — |

## Other

- **Enumeration date:** 05/11/2006
- **Last updated:** 01/16/2020