Individual
MICHAEL JOHN PROVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AA
Contact information
Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610-3003
(352) 265-0077
(352) 265-6922
Mailing address
PO BOX 918025, ORLANDO, FL 32891-8025
(352) 265-0077
(352) 265-6922
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
AA41
FL
Other
Enumeration date
10/15/2009
Last updated
02/15/2010
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