Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Robert Provenzano, MD

Individual provider Nephrology Physician · NPI 1972505584

Dr. Robert Provenzano, MD is a Nephrology Physician in Portland, Oregon. Licensed in Arizona, Colorado, Florida and Idaho and 6 more. Registered with an NPI since 2005.

Licensed in
AZ, CO, FL, ID, MI, NC
In the registry since
2005
Specialties on file
11
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1547 NE 40th Ave Ste B
Portland, OR 97232-1862
Phone: (855) 397-0197
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nephrology Physician (primary) Taxonomy 207RN0300X · Licence RP047354 (MI)
Nephrology Physician Taxonomy 207RN0300X · Licence M-11205 (ID)
Nephrology Physician Taxonomy 207RN0300X · Licence 4301047354 (MI)
Nephrology Physician Taxonomy 207RN0300X · Licence 54729 (AZ)
Nephrology Physician Taxonomy 207RN0300X · Licence 2017-00405 (NC)
Nephrology Physician Taxonomy 207RN0300X · Licence 40429 (SC)
Nephrology Physician Taxonomy 207RN0300X · Licence MD463387 (PA)
Nephrology Physician Taxonomy 207RN0300X · Licence ME118456 (FL)
Nephrology Physician Taxonomy 207RN0300X · Licence 48234 (CO)
Nephrology Physician Taxonomy 207RN0300X · Licence MD0000053388 (TN)
Nephrology Physician Taxonomy 207RN0300X · Licence MD170613 (OR)

Record details

NPI number1972505584
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedAugust 12, 2005
Last updated in NPPESNovember 26, 2019
Mailing address1840 E Ray Rd, Chandler, AZ 85225-8720

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