Provenzano, Robert

Provenzano, Robert is an individual health care provider with primary practice located at 1547 Ne 40Th Ave Ste B , Portland OR 97232-1862. He recently has only one registered license in Allopathic & Osteopathic Physicians / Nephrology, which is considered as his primary health care specialty. Provenzano, Robert can be contacted via phone (855) 397-0197.

Contact Information

Primary practice address
1547 Ne 40Th Ave Ste B Portland OR 97232-1862
Phone: (855) 397-0197
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X M-11205 Idaho
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X 4301047354 Michigan
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X 54729 Arizona
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X 2017-00405 North Carolina
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X 40429 South Carolina
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X MD463387 Pennsylvania
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X ME118456 Florida
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X 48234 Colorado
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X MD0000053388 Tennessee
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X MD170613 Oregon
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X RP047354 Michigan

Profile Details

NPI number 1972505584
LBN Legal business name Provenzano, Robert
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 12th, 2005
Last updated Nov 26th, 2019 - about 6 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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