David G Provaznik DO Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

34005337 Issued in OH

Legal business name

DAVID G PROVAZNIK DO INC

Practice address

11826 Gallia Pike Rd
Suite a
Wheelersburg, OH 45694-9119

Phone

(740) 574-4526

Fax

(740) 574-2895

NPI assigned

Aug 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David Gerard Provaznik, DONPI 1245267624

Title

President/Ceo

Phone

(740) 574-4526

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David Gerard Provaznik, DO

  • Family Medicine Physician
  • Wheelersburg, OH
  • NPI 1245267624
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274140800000",
    "number": "1780799775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11826 GALLIA PIKE RD",
            "address_2": "SUITE A",
            "city": "WHEELERSBURG",
            "state": "OH",
            "postal_code": "456949119",
            "telephone_number": "740-574-4526",
            "fax_number": "740-574-2895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11826 GALLIA PIKE RD",
            "address_2": "SUITE A",
            "city": "WHEELERSBURG",
            "state": "OH",
            "postal_code": "456949119",
            "telephone_number": "740-574-4526",
            "fax_number": "740-574-2895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID G PROVAZNIK DO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2010-05-18",
        "status": "A",
        "authorized_official_last_name": "PROVAZNIK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "GERARD",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "740-574-4526",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34005337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0965915",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark E Cox
• Bryan K Craft, HH AIDE
• Roger A Craft
• Deanna Crawford, CNP
• Rodney Crock, DO
• Carl W Davis Jr.
• Jason E Day
• David Allen Days, R.PH
• Tisha Nicole Delabar
• Trenda Kay Denney

• Family Medicine Physician in Wheelersburg, OH
• Providers in Wheelersburg, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.