Individual
MARTY SCOTT PROVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
700 S J ST, LAKEVIEW, OR 97630-1623
(541) 947-6021
Mailing address
700 S J ST, LAKEVIEW, OR 97630-1623
(541) 947-6021
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
OR
Other
Enumeration date
09/14/2022
Last updated
09/14/2022
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