Individual
DR. DOUGLAS PROVAZNIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4301 W MARKHAM ST # 589, LITTLE ROCK, AR 72205-7199
(501) 526-8148
Mailing address
4301 W MARKHAM ST # 589, LITTLE ROCK, AR 72205-7199
(501) 526-8148
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
E-14627
AR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/02/2018
Last updated
01/31/2022
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