Individual
JILL M PROVAZNIK
Active
Individual
JILL M PROVAZNIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD189615
OR
207RI0200X
Infectious Disease Physician
11262304-1205
UT
207RI0200X
Infectious Disease Physician
Primary
MD189615
OR
Other
Enumeration date
06/04/2015
Last updated
05/12/2023
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