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Individual
COLIN DEANE DAVENPORT
Active
Individual
COLIN DEANE DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
71016312A
IN
363L00000X
Nurse Practitioner
Primary
71016312A
IN
Other
Enumeration date
09/29/2023
Last updated
07/20/2026
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