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General NPI Number Information
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NPI Number | 1386004950
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Entity Type | Individual
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Provider Name | ERIC A DAVENPORT RD
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Gender | Male
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Dates
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Enumeration Date | 02/25/2016
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 411 E CHESTNUT ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-1713
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Country | US
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Telephone | 502-588-3400
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Fax | 502-588-3401
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Provider Business Mailing Address
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Address Line | PO BOX 909
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City | LOUISVILLE
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State | KY
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Zip | 40201-0909
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Country | US
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Telephone | 502-588-3400
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Fax | 502-588-3401
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 165271
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License Number State | KY
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