Individual
DR. PAUL THOMAS PROVANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
JAMES H QUILLEN VA MEDICAL CENTER, MOUNTAIN HOME, TN 37684-4000
(423) 926-1171
Mailing address
PO BOX 4000, MOUNTAIN HOME, TN 37684-4000
(423) 926-1171
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35.086268
OH
207R00000X
Internal Medicine Physician
Primary
MD41434
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2571293
—
OH
05
—
3825653
—
TN
Enumeration date
05/31/2006
Last updated
11/08/2010
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