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General NPI Number Information
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NPI Number | 1174517403
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Entity Type | Individual
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Provider Name | WILLIAM J PROVANCE DO
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Gender | Male
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Dates
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Enumeration Date | 09/01/2005
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Last Update Date | 09/04/2014
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Provider Practice Location Address
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Address Line | 681 GOODLETTE RD N STE 130
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City | NAPLES
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State | FL
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Zip | 34102-5458
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Country | US
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Telephone | 239-643-9767
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Fax | 239-649-5878
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Provider Business Mailing Address
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Address Line | 3434 HANCOCK BRIDGE PKWY STE 301
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City | NORTH FORT MYERS
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State | FL
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Zip | 33903-7094
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Country | US
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Telephone | 877-856-3774
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Fax | 239-599-2625
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | OS12406
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License Number State | FL
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