Provenzano, Mark Phillip

Provenzano, Mark Phillip is an individual health care provider with primary practice located at 950 Campbell Rd , Houston TX 77024-2804. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Provenzano, Mark Phillip can be contacted via phone (713) 464-0077.

Contact Information

Primary practice address
950 Campbell Rd Houston TX 77024-2804
Phone: (713) 464-0077
Fax: (713) 464-9582
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207XX0005X 207XX0005X Texas

Profile Details

NPI number 1811094584
LBN Legal business name Provenzano, Mark Phillip
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 17th, 2006
Last updated May 23rd, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1811094584 NPPES
Texas Other MDG3705 LICENSE NUMBER
Texas Other 0025EP LICENSE NUMBER

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