Individual
SPENCER LANCE DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4403 HARRISON BLVD STE 2600, OGDEN, UT 84403-3277
(801) 387-5620
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 643-1108
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5929015-8906
UT
Other
Enumeration date
09/23/2011
Last updated
08/10/2021
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