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General NPI Number Information
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NPI Number | 1528238201
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Entity Type | Organization
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Legal Business Name | CHRISTOPHER DAVENPORT MD MBA PA
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 207 PALMOLA ST
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City | LAKELAND
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State | FL
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Zip | 33803-2242
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Country | US
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Telephone | 863-646-9600
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Fax | 330-422-6245
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Provider Business Mailing Address
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Address Line | 207 PALMOLA ST
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City | LAKELAND
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State | FL
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Zip | 33803-2242
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Country | US
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Telephone | 863-646-9600
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Fax | 330-422-6245
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER VERNON DAVENPORT
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Credential | M.D.
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Telephone | 863-646-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME0087596
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License Number State | FL
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