Individual
DAVID ANDERS PROVOST JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-8800
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
H4629
TX
Other
Enumeration date
04/17/2006
Last updated
01/05/2021
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