Organization
PLANT CITY ALLERGY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID E. PROVENCHER JR. M.D. (OWNER-PHYSICIAN)
(813) 752-8595
Entity
Organization
Contact information
Practice address
106 SOUTHERN OAKS DR, PLANT CITY, FL 33563-1446
(813) 752-8595
Mailing address
PO BOX 2156, PLANT CITY, FL 33564-2156
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
ME81615
FL
Other
Enumeration date
01/26/2007
Last updated
08/22/2020
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