Individual
WILLIAM J PROVANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
681 GOODLETTE RD N, STE 130, NAPLES, FL 34102-5458
(239) 643-9767
(239) 649-5878
Mailing address
3434 HANCOCK BRIDGE PKWY, STE 301, NORTH FORT MYERS, FL 33903-7094
(877) 856-3774
(239) 599-2625
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
OS12406
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0013977160006
—
PA
01
—
P00252222
PALMETTOGBA
PA
Enumeration date
09/01/2005
Last updated
09/04/2014
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