Individual
MR. JOHN MARSHALL PROVOST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.PED
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
4244780002
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A08009797
MEDICARE EDI BILLING NUMB
PA
Enumeration date
03/21/2007
Last updated
07/08/2007
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