Healthcare Provider Details

I. General information

NPI: 1558353052
Provider Name (Legal Business Name): DAVID E DAVENPORT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 N VERCLER RD STE 101
SPOKANE VALLEY WA
99216-1020
US

IV. Provider business mailing address

PO BOX 3868
SPOKANE WA
99220-3868
US

V. Phone/Fax

Practice location:
  • Phone: 509-228-1000
  • Fax: 509-252-9300
Mailing address:
  • Phone: 509-228-1000
  • Fax: 509-252-9300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberM5335
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: