Individual
JOHN MICHAEL PROVENZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BOULEVARD, WINSTON SALEM, NC 27157-1900
(336) 713-7311
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 713-7777
(336) 716-1119
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
2023-01626
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/08/2017
Last updated
06/12/2023
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