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Organization

MARK PROVENZANO MD PA

Active
Other names
THE ORTHOPEDIC SPORTS CLINIC
Organization subpart
No

Provider details

NPI number
Authorized official
KRISTY MCDOWELL (BILLING/INSURANCE)
(713) 464-0077
Entity
Organization

Contact information

Practice address
950 CAMPBELL RD, HOUSTON, TX 77024-2804
(713) 464-0077
(713) 464-9582
Mailing address
PO BOX 3961, HOUSTON, TX 77253-3961

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G3705
TX

Other

Enumeration date
12/17/2007
Last updated
06/24/2008
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