Individual
RANDY LEE PROVINCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
911 E MAIN ST, FLOYD, VA 24091-4183
(540) 745-0231
(540) 745-4028
Mailing address
229 MORRISON AVE, PEMBROKE, VA 24136-3003
(304) 685-1732
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102206605
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/10/2018
Last updated
04/15/2022
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