MARK PHILLIP PROVENZANO (NPI# 1811094584) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811094584 |
| Entity Type | Individual |
| Full Name | MARK PHILLIP PROVENZANO |
| Credential | M.D. |
| Practice Address |
950 Campbell Rd Houston TX 77024-2804 |
| Practice Telephone | 7134640077 |
| Practice Fax Number | 7134649582 |
| Mailing Telephone | 7134640077 |
| Mailing Fax Number | 7134649582 |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2014-05-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
207XX0005X | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | BCBS PROVIDER # | 0025EP | 01 |
| TX | LICENSE NUMBER | MDG3705 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942486428 | Mark A Provenzano | Optometrist | 123 Circle Way, Lake Jackson, TX 77566-5233 | 2008-01-15 |
| 1982791679 | Mark Anthony Provenzano | Internal Medicine | 389 New Castle Rd, Butler, PA 16001-1743 | 2006-10-06 |
| Street Address |
950 CAMPBELL RD |
| City | HOUSTON |
| State | TX |
| Zip Code | 77024-2804 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629035894 | Juan C Bustos | Orthopaedic Surgery | 950 Campbell Rd, Houston, TX 77024 | 2006-04-29 |
| 1245795798 | Wesley-viet Dinh Vu | Physical Therapy Assistant | 950 Campbell Rd, Houston, TX 77024-2804 | 2019-02-08 |
| 1093253080 | Wendy Alexander | Specialist/Technologist, Other | 950 Campbell Rd, Houston, TX 77024-2804 | 2017-02-09 |
| 1245782432 | Danielle Marie Lavoy | Physician Assistant | 950 Campbell Rd, Houston, TX 77024-2804 | 2016-11-04 |
| 1144612037 | Badlani Spine & Pain Pllc | Orthopaedic Surgery | 950 Campbell Rd, Houston, TX 77024-2804 | 2015-03-02 |
| 1093948655 | Juan C Bustos Md Pa | Clinic/Center | 950 Campbell Rd, Houston, TX 77024-2804 | 2009-08-31 |
| 1720261456 | Mark Provenzano Md Pa | Specialist | 950 Campbell Rd, Houston, TX 77024-2804 | 2007-12-17 |
| 1598858565 | Carl Frank Palumbo | Orthopaedic Surgery | 950 Campbell Rd, Houston, TX 77024-2804 | 2006-10-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154955664 | Candace L Lillibridge | Physical Therapist | 700 Town & Country Blvd, Suite 2490, Houston, TX 77024 | 2020-02-24 |
| 1952940728 | Generations Provider Services LLC | Technician | 12633 Memorial Dr #242 Unit, Houston, TX 77024 | 2019-12-27 |
| 1912540352 | Francesca Penner | Psychologist | 920 Frostwood Drive, Suite 670 and 680, Houston, TX 77024 | 2019-10-17 |
| 1407498553 | Charles Hooks Iv | Technician | 12119 Perthshire Rd, Houston, TX 77024 | 2019-10-10 |
| 1427614379 | Texas Regional Clinic | Pain Medicine | 8301 Katy Freeway, Suite 101, Houston, TX 77024 | 2019-05-16 |
| 1922663871 | Fast Premier Transport LLC | Secured Medical Transport (VAN) | 811 Town and Country Blvd., Suite 141, Houston, TX 77024 | 2019-05-07 |
| 1205317534 | Hiro Health Corporation | Durable Medical Equipment & Medical Supplies | 8584 Katy Freeway, Suite 422, Houston, TX 77024 | 2018-08-24 |
| 1548799901 | K Med Pharmacy | Pharmacy | 11900 Barryknoll #6109, Houston, TX 77024 | 2017-06-08 |
| 1184166712 | Baylor College of Medicine | Clinic/Center | 8660 Memorial Drive, Houston, TX 77024 | 2016-11-14 |
| 1376092197 | Elyse Sears Dds Pllc | Dentist | 803 W Sam Houston Pkwy N, Ste 124, Houston, TX 77024 | 2016-09-22 |
| Find all providers in zip 77024 | ||||
| Taxonomy Code | 207XX0005X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Sports Medicine |
| An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton changed, source changed] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. ACGME Accredited Program Requirements: 1 year GME in the specialty + 5 years of Orthopaedic Surgery for a total of 6 years |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194223644 | James R. Bocell | Orthopaedic Surgery | 2639 Fenwood Rd, Houston, TX 77005-3435 | 2018-01-30 |
| 1073039244 | Aa Orthopedics | Orthopaedic Surgery | 2302 Fannin St Ste 410, Houston, TX 77002-9135 | 2017-08-18 |
| 1598203580 | Tmh Physician Associates Pllc | Orthopaedic Surgery | 12211 Kirby Dr, Suite 200, Houston, TX 77045-4859 | 2017-02-09 |
| 1033657002 | Tmh Physician Associates Pllc | Orthopaedic Surgery | 5505 West Loop S Ste 100, Houston, TX 77081 | 2017-02-09 |
| 1407266844 | Mark R Rogers Md Pa | Orthopaedic Surgery | 12000 Richmond Ave Ste 370, Houston, TX 77082-2964 | 2014-05-07 |
| 1639335359 | James Matthew Gregory | Orthopaedic Surgery | 929b Gessner Rd Ste 100, Houston, TX 77024-2854 | 2008-08-01 |
| 1801059977 | Angelo Dushi Parameswaran | Orthopaedic Surgery | 22485 Tomball Pkwy Ste 2100, Houston, TX 77070-1560 | 2008-07-08 |
| 1457499071 | Anastassios Karistinos | Orthopaedic Surgery | 6620 Main Street Suite 1325, Houston, TX 77030 | 2007-02-03 |
| 1770673428 | Mark Stephen Adickes | Orthopaedic Surgery | 7200 Cambridge St Fl 10, Houston, TX 77030-4202 | 2006-10-13 |
| 1093322075 | Para-raghu, LLC | Orthopaedic Surgery | 2302 Fannin St Ste 410, Houston, TX 77002-9135 | 2020-09-24 |
| Find all providers in HOUSTON | ||||
Please comment or provide details below to improve the information on MARK PHILLIP PROVENZANO.
| 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.