Evan Paul Provisor, MD
NPI #1366427429 in Southbridge, Massachusetts
Provider Information
- NPI Number
- 1366427429
- Entity Type
- Individual
- Name
- Evan Paul Provisor, MD
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Surgery
- Credential
- MD
- Enumeration Date
- Dec 13, 2005
- Last Updated
- Dec 21, 2011
Practice Location
- Address
- 94 SOUTH ST
- City
- Southbridge
- State
- Massachusetts
- ZIP Code
- 01550-4000
- Phone
- (508) 764-6966
Specialties & Taxonomy Codes
| Specialty |
|---|
| Surgery |
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