Individual
DR. PAUL THOMAS PROVANCE
Active
Individual
DR. PAUL THOMAS PROVANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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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