| NPI | 1881095479 |
|---|---|
| Doing Business As | J PROVO, MD |
| Entity Type | Organization |
| Authorized Contact | DANE TRASK COO 813-787-1128 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2015-10-02 |