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General NPI Number Information
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NPI Number | 1063730570
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Entity Type | Individual
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Provider Name | JONATHAN ACOB DAVENPORT M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/07/2010
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Last Update Date | 04/10/2019
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Provider Practice Location Address
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Address Line | 616 RAILROAD AVE STE 1&2
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City | ZILLAH
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State | WA
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Zip | 98953
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Country | US
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Telephone | 509-972-1190
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Fax | 509-249-4458
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Provider Business Mailing Address
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Address Line | 3800 SUMMITVIEW AVE
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City | YAKIMA
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State | WA
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Zip | 98902-2715
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Country | US
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Telephone | 509-248-7949
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Fax | 509-248-8291
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD60297882
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License Number State | WA
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