Healthcare Provider Details

I. General information

NPI: 1912468042
Provider Name (Legal Business Name): BARRY ISAAC DAVENPORT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 1ST ST BLDG 46
ALTUS OK
73523-5004
US

IV. Provider business mailing address

301 N 1ST ST BLDG 46
ALTUS OK
73523-5004
US

V. Phone/Fax

Practice location:
  • Phone: 580-481-5230
  • Fax:
Mailing address:
  • Phone: 580-481-5230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberS9125
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number37355
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberS9125
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: