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General NPI Number Information
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NPI Number | 1770699449
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Entity Type | Organization
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Legal Business Name | JEFFREY C. DAVENPORT, MD, PC
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 105 S BRYANT AVE SUITE 301
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City | EDMOND
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State | OK
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Zip | 73034-6399
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Country | US
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Telephone | 405-341-1234
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Fax | 405-359-1770
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Provider Business Mailing Address
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Address Line | 105 S BRYANT AVE SUITE 301
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City | EDMOND
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State | OK
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Zip | 73034-6399
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Country | US
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Telephone | 405-341-1234
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Fax | 405-359-1770
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY C DAVENPORT
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Credential | MD
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Telephone | 405-341-1234
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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 | 24933
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License Number State | OK
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