Organization
DAVID G PROVAZNIK DO INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID GERARD PROVAZNIK DO (PRESIDENT/CEO)
(740) 574-4526
Entity
Organization
Contact information
Practice address
11826 GALLIA PIKE RD, SUITE A, WHEELERSBURG, OH 45694-9119
(740) 574-4526
(740) 574-2895
Mailing address
11826 GALLIA PIKE RD, SUITE A, WHEELERSBURG, OH 45694-9119
(740) 574-4526
(740) 574-2895
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34005337
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0965915
—
OH
Enumeration date
08/20/2006
Last updated
05/18/2010
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