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DR. ROBERT PROVENZANO MD
NPI 1972505584
Internal Medicine - Nephrology in Portland, OR

Active since August 12, 2005
1547 NE 40TH AVE STE B, PORTLAND, OR 97232(855) 397-0197 Get Directions Write a Review

NPPES record last updated: November 26, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Nov 26, 2019, Nov 26, 2018, Feb 17, 2016 (3 updates tracked since 2016).

About Dr. Robert Provenzano Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. ROBERT PROVENZANO MD (NPI 1972505584) is an individual nephrology provider in Portland, Oregon, licensed in Michigan (RP047354) and active in the NPI registry since August 2005.

NPPES Registry Identity

NPI1972505584
Entity TypeIndividualMale
Primary Taxonomy207RN0300X
Provider Legal NameDR. ROBERT PROVENZANOCredential: MD
Location Address1547 NE 40TH AVE STE BPortland, OR 97232-1862
Mailing Address1840 E Ray RdChandler, AZ 85225-8720 · (855) 397-0197 · Fax (800) 272-6512
Phone(855) 397-0197
Sole ProprietorNo
Enumeration DateAugust 12, 2005
Last NPPES UpdateNovember 26, 20193 updates tracked since enumeration
✔ NPI 1972505584 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · NephrologyAllopathic & Osteopathic Physicians
Taxonomy Code207RN0300X
Licenses✔ Licensed in MI · RP047354✔ Licensed in ID · M-11205✔ Licensed in MI · 4301047354✔ Licensed in AZ · 54729✔ Licensed in NC · 2017-00405✔ Licensed in SC · 40429✔ Licensed in PA · MD463387✔ Licensed in FL · ME118456✔ Licensed in CO · 48234✔ Licensed in TN · MD0000053388✔ Licensed in OR · MD170613
Definition
An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.
1547 NE 40TH AVE STE B, Portland, OR 97232
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Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. SUPRIYA KHAN MD
Internal Medicine (Nephrology)
1547 NE 40TH AVE STE B
PORTLAND, OR 97232
Multnomah County (503) 284-1937
DR. SALLIE E ISRAELIT MD
Internal Medicine (Nephrology)
1547 NE 40TH AVE STE B
PORTLAND, OR 97232
Multnomah County (503) 284-1937
STACY LANDERS PA-C
Physician Assistant
1547 NE 40TH AVE STE B
PORTLAND, OR 97232
Multnomah County (503) 284-1937

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Robert Provenzano's NPI number?

The NPI number for Robert Provenzano is 1972505584. It was assigned to this individual provider in the NPPES registry on August 12, 2005.

Where is Robert Provenzano located?

Robert Provenzano practices at 1547 NE 40th Ave Ste B, Portland, OR 97232. The listed phone number is (855) 397-0197.

What is Robert Provenzano's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Nephrology, with taxonomy code 207RN0300X.

When was this NPI record last updated?

The NPPES record for Robert Provenzano was last updated on November 26, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.