JOHN M PROVENZA

SHREVEPORT, LA
NPI1225028434
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207RG0100X Internal Medicine Gastroenterology
(Licence: LA  017860)
Enumeration Date2005-10-27
Last Update Date2022-08-12
Business Address
JOHN M PROVENZA M.D.
8383 MILLICENT WAY STE B
SHREVEPORT, LA 71115
Phone number: 318-631-9121
Mailing Address
JOHN M PROVENZA M.D.
3217 MABEL ST
SHREVEPORT, LA 71103-4022
Phone number: 318-631-9121
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