Individual
DR. TERRY EVERT DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
229 S 8TH ST, ST MARIES, ID 83861-1813
(208) 245-2591
(208) 245-5246
Mailing address
229 S 8TH ST, ST MARIES, ID 83861-1813
(208) 245-2591
(208) 245-5246
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O-130
ID
208M00000X
Hospitalist Physician
O-130
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010004699
REGENCE BS OF ID
ID
01
—
123363
DEPT OF LABOR&INDUSTRIES
WA
01
—
601415700
DEEIOC
—
05
—
805169900
—
ID
05
—
8434839
—
WA
01
—
S1303
BLUE CROSS OF ID
ID
Enumeration date
09/30/2005
Last updated
11/15/2023
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