JOHN M PROVENZA (NPI# 1225028434) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225028434 |
| Entity Type | Individual |
| Full Name | JOHN M PROVENZA |
| Credential | M.D. |
| Practice Address |
8383 Millicent Way Ste B Shreveport LA 71115 |
| Mailing Address |
3217 Mabel St Shreveport LA 71103-4022 |
| Practice Telephone | 3186319121 |
| Practice Fax Number | 3182136246 |
| Mailing Telephone | 3186319121 |
| Mailing Fax Number | 3186386018 |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2018-06-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
017860 | LA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1376442 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508399346 | John Michael Provenza | Student in an Organized Health Care Education/Training Program | 625 19th St S, Birmingham, AL 35233-1900 | 2017-04-08 |
| Street Address |
8383 MILLICENT WAY STE B |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71115 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851768642 | Jennifer M Brown | Physician Assistant | 8383 Millicent Way Ste B, Shreveport, LA 71115 | 2015-08-27 |
| 1194133421 | Amy Alisha Stinson | Nurse Practitioner | 8383 Millicent Way Ste B, Shreveport, LA 71115-5207 | 2014-07-30 |
| 1346521945 | Seth W Miller | Physician Assistant | 8383 Millicent Way Ste B, Shreveport, LA 71115 | 2011-09-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740829217 | Bno Surgical Consultants, LLC | Physician Assistant | 303 Captain Hm Shreve Blvd, Shreveport, LA 71115 | 2020-01-02 |
| 1902310899 | Islam LLC | General Acute Care Hospital | 9815 Paragon Ln, Shreveport, LA 71115 | 2017-11-30 |
| 1508304569 | Marcel White | Case Manager/Care Coordinator | 9050 Youree Dr, Apt 105, Shreveport, LA 71115 | 2017-02-09 |
| 1114392784 | Marilyn Sparks | Counselor | 9999 Smitherman Dr Apt 502, Shreveport, LA 71115 | 2015-12-08 |
| 1699031237 | Cody Tingle | Internal Medicine | 8001 Youree Dr Ste 400, Shreveport, LA 71115 | 2012-04-09 |
| 1629366885 | Pankaj Sharma | Psychiatry & Neurology | Department of Neurology, Lsuhsc Shreveport, 1501 Kings Highway, Shreveport, LA 71115 | 2011-07-21 |
| 1396914750 | Lisa L Jawahar | Radiologic Technologist | 429 Creek Holw, Shreveport, LOUISIANA 71115 | 2008-02-29 |
| 1720291412 | Larry Kenneth Robinson Jr. | Dentist | 8856 Youree Dr, Suite C, Shreveport, LA 71115 | 2007-05-08 |
| 1952471609 | Shining Star Professional Services Inc | Social Worker | 9050 Youree Drive, #1004, Shreveport, LA 71115 | 2006-11-09 |
| 1922178854 | Akee Lj Jackson | Social Worker | 9050 Youree Dr. #1004, Shreveport, LA 71115 | 2006-11-08 |
| Find all providers in zip 71115 | ||||
| Taxonomy Code | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750600748 | Elvin Hardy | Internal Medicine | 505 Seneca Trl, Shreveport, LA 71107-5424 | 2010-05-31 |
| 1083716344 | Harry L Hawkins Jr. | Internal Medicine | 253 Wedgewood Dr, Shreveport, LA 71105-4125 | 2006-09-05 |
| 1316982853 | Aderonke Akingbola Md and Willis-knighton Medical Center | Internal Medicine | 2514 Bert Kouns Loop, Suite 1, Shreveport, LA 71118-3146 | 2006-06-18 |
| 1184663171 | Stephanie Barnes | Internal Medicine | 1534 Elizabeth Ave, Shreveport, LA 71101-4516 | 2006-06-05 |
| 1760478465 | David A. Scott | Internal Medicine | 1801 Fairfield Ave Ste 305, Shreveport, LA 71101-4467 | 2005-09-27 |
| 1528061959 | Amit Ahuja | Internal Medicine | 2551 Greenwood Rd, Suite 350, Shreveport, LA 71103-3981 | 2005-05-31 |
| 1861495822 | Michael Bivens Brannan | Internal Medicine | 3217 Mabel St, Shreveport, LA 71103-4022 | 2005-05-24 |
| 1003285255 | Wk Digestive Disease Consultants | Internal Medicine | 2508 Bert Koun Loop, Sutie 304, Shreveport, LA 71118-3133 | 2015-09-17 |
| 1982087755 | Hrishikesh Samant | Internal Medicine | 1501 Kings Hwy, Lsuhsc, Shreveport, LA 71103-4228 | 2015-06-30 |
| 1255754966 | Christus Highland Physician Group | Internal Medicine | 1453 E Bert Kouns Loop, Shreveport, LA 71105-6800 | 2014-01-31 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71115 |
Please comment or provide details below to improve the information on JOHN M PROVENZA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.