Organization
DONALD D DAVENPORT JR D O P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD D DAVENPORT JR. D.O. (OWNER PHYSICIAN)
(432) 580-8330
Entity
Organization
Contact information
Practice address
540 W 5TH ST STE 470, ODESSA, TX 79761-5070
(432) 580-8330
(432) 580-8333
Mailing address
540 W 5TH ST STE 470, ODESSA, TX 79761-5070
(432) 580-8330
(432) 580-8333
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
L0118
TX
2086S0102X
Surgical Critical Care Physician
Primary
L0118
TX
2086S0120X
Pediatric Surgery Physician
L0118
TX
2086S0127X
Trauma Surgery Physician
L0118
TX
2086X0206X
Surgical Oncology Physician
L0118
TX
208C00000X
Colon & Rectal Surgery Physician
L0118
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0017HG
GROUP # BCBS
TX
Enumeration date
03/19/2007
Last updated
04/14/2008
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