Individual
JAMES E PROVO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4705 N FEDERAL HWY, BOCA RATON, FL 33431-5135
(561) 220-2622
(561) 257-1922
Mailing address
180 JOHN F KENNEDY DR STE 100, ATLANTIS, FL 33462-6641
(561) 967-6500
(561) 314-7201
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
ME67309
FL
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
ME67309
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27095
BLUE CROSS BLUE SHIELD
FL
05
—
377506200
—
FL
Enumeration date
06/29/2006
Last updated
06/06/2024
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