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MARK PHILLIP PROVENZANO M.D. NPI 1811094584


NPI Information

NPI: 1811094584
Provider Name: MARK PHILLIP PROVENZANO, M.D.
Classification: Orthopaedic Surgery - 207XX0005X
Entity Type: Individual

Specialization: Sports Medicine

PECOS Registration: Yes

Address:
950 CAMPBELL RD
HOUSTON, TX
ZIP 77024
Phone: (713) 464-0077
Get Directions

Mark Phillip Provenzano, M.D. is a sports medicine orthopaedic surgery in Houston, TX with 42 years of experience. The provider is 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. Mark Phillip Provenzano, M.D. NPI is 1811094584. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: BAYLOR COLLEGE OF MEDICINE
Graduation Year:1982

The provider's business location address is:

950 CAMPBELL RD
HOUSTON, TX
ZIP 77024-804
Phone: (713) 464-0077
Fax: (713) 464-9582

The NPI 1811094584 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/17/2006 and was last updated on 5/23/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207XX0005XOrthopaedic SurgerySports Medicine207XX0005XTEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
10025EPOTHERTEXASBCBS PROVIDER #
2B25664MEDICARE UPINTEXAS
3MDG3705OTHERTEXASLICENSE NUMBER
400DE37MEDICARE PINTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.