John M Provenza is a Gastroenterology Physician based in Shreveport, LA and is specialized in Gastroenterology. John M Provenza practices in Shreveport, LA and has the professional credentials of MD. The NPI Number for John M Provenza is 1225028434 and holds a License No. 017860 (Louisiana).
The current practice location address for John M Provenza is 8383 Millicent Way Ste B, Shreveport, LA and can be reached out via phone at 318-631-9121 and via fax at 318-213-6246. You can also correspond with John M Provenza through the mailing address at 3217 MABEL ST, SHREVEPORT, LA - 71103-4022 (mailing address contact number: 318-631-9121).
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MD.017860 | 01 | LA | STATE LICENSE |
| 1376442 | 05 | LA |
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