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Individual

DR. JERRY M. DAVENPORT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D. O.

Contact information

Practice address
306 W 5TH AVE, NORTON SOUND HEALTH COOPERATION, NOME, AK 99762
(907) 443-3214
Mailing address
9223 STONE RIDGE CIR, SANDY, UT 84093-2698
(801) 944-1335
(801) 944-1335

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4105
AK

Other

Enumeration date
03/28/2007
Last updated
01/26/2011
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