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Contact Information

DAVID E PROVENCHER JR, MD
106 SOUTHERN OAK DRIVE
PLANT CITY, FL33563
 Phone: 813-752-8595
 Fax: 813-752-8088
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Allergy & Immunology

207K00000X 03 Physician/Allergy/ Immunology
 

Pediatric Allergy/Immunology

2080P0201X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for DAVID E PROVENCHER JR · (Male)

NPI Number 1326098120
Status Active
Credentials MD
Entity Individual
Enumeration date 05/11/2006
Last updated 01/16/2020 - About 6 years ago
Sole proprietor 1 Yes
Identifiers
  • FL License # ME81615
  • FL Medicaid 262145201
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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