Individual
DR. DAVID E. PROVENCHER JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
106 SOUTHERN OAK DRIVE, PLANT CITY, FL 33563
(813) 752-8595
(813) 752-8088
Mailing address
PO BOX 2156, PLANT CITY, FL 33564-2156
(813) 486-2085
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
ME81615
FL
2080P0201X
Pediatric Allergy/Immunology Physician
ME81615
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
262145201
—
FL
Enumeration date
05/11/2006
Last updated
01/16/2020
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