Individual
DEREK JOSEPH DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4095 E PONY EXPRESS PKWY STE 1, EAGLE MOUNTAIN, UT 84005-5531
(801) 429-8037
(801) 753-7476
Mailing address
1055 N 500 W, ATTN. CREDENTIALING, PROVO, UT 84604
(801) 354-8225
(801) 418-0941
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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