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General NPI Number Information
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NPI Number | 1346278264
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Entity Type | Individual
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Provider Name | JAMES E PROVO MD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 4705 N FEDERAL HWY
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City | BOCA RATON
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State | FL
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Zip | 33431-5135
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Country | US
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Telephone | 561-220-2622
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Fax | 561-257-1922
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Provider Business Mailing Address
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Address Line | 180 JOHN F KENNEDY DR STE 100
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City | ATLANTIS
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State | FL
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Zip | 33462-6641
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Country | US
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Telephone | 561-967-6500
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Fax | 561-314-7201
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME67309
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | ME67309
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License Number State | FL
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