Provider Demographics
NPI:1083760748
Name:PLANT CITY ALLERGY, P.A.
Entity Type:Organization
Organization Name:PLANT CITY ALLERGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:PROVENCHER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:813-752-8595
Mailing Address - Street 1:PO BOX 2156
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33564-2156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:106 SOUTHERN OAKS DR
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-1446
Practice Address - Country:US
Practice Address - Phone:813-752-8595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81615207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH46274Medicare UPIN
FLK5408Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER