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Individual
DEREK JOSEPH DAVENPORT
Active
Individual
DEREK JOSEPH DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
11327523-1205
UT
207R00000X
Internal Medicine Physician
MD162235
OR
208000000X
Pediatrics Physician
Primary
11327523-1205
UT
208000000X
Pediatrics Physician
MD162235
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1346484581
NPI
—
05
—
500659989
—
OR
Enumeration date
04/30/2009
Last updated
11/27/2023
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