Individual
ROBERT A PROVENCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
296 KINGS HIGHWAY, CLARKSBORO, NJ 08020
(856) 423-7000
Mailing address
296 KINGS HIGHWAY, CLARKSBORO, NJ 08020
(856) 423-7000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MB04853900
NJ
Other
Enumeration date
07/03/2006
Last updated
06/28/2010
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