Individual
DR. ROBERT PROVENZANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1547 NE 40TH AVE STE B, PORTLAND, OR 97232-1862
(855) 397-0197
Mailing address
1840 E RAY RD, CHANDLER, AZ 85225-8720
(855) 397-0197
(800) 272-6512
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
2017-00405
NC
207RN0300X
Nephrology Physician
40429
SC
207RN0300X
Nephrology Physician
4301047354
MI
207RN0300X
Nephrology Physician
48234
CO
207RN0300X
Nephrology Physician
54729
AZ
207RN0300X
Nephrology Physician
M-11205
ID
207RN0300X
Nephrology Physician
MD0000053388
TN
207RN0300X
Nephrology Physician
MD170613
OR
207RN0300X
Nephrology Physician
MD463387
PA
207RN0300X
Nephrology Physician
ME118456
FL
207RN0300X
Nephrology Physician
Primary
RP047354
MI
Other
Enumeration date
08/12/2005
Last updated
11/26/2019
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