License holder summary

PROVOST DOUGLAS E is a Medicine (Physician, Including M Ds & D Os) licensed to practice in New York. The address on file for PROVOST DOUGLAS E is QUEENSBURY NY. This doctor license is current. The license was granted 04/14/1978 and expired on 04/30/2016.

New York

Office of the Professions

PROVOST DOUGLAS E
Medicine (Physician, Including M Ds & D Os)
License number
134188
Date granted
04/14/1978
Date expires
04/30/2016
Class
Medicine (Physician, Including M Ds & D Os)
Status
Registered
Address
QUEENSBURY NY
nymedicine.org
ID 30249365
LAST UPDATED 2024-04-30 00:52:54 UTC

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