Individual
DR. DAVID GERARD PROVAZNIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
11826 GALLIA PIKE, SUITE A, WHEELERSBURG, OH 45694-9119
(740) 574-4526
(740) 574-2895
Mailing address
PO BOX 2379, ASHLAND, KY 41105-2379
(740) 574-4526
(740) 574-2895
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34005337
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0842315
—
OH
Enumeration date
06/28/2006
Last updated
02/12/2014
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