Individual
GARY B DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
US ROUTES 219 & 250, MILL CREEK, WV 26280-0000
(304) 335-2050
(304) 335-6158
Mailing address
PO BOX 247, MILL CREEK, WV 26280-0247
(304) 335-2050
(304) 335-6158
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
21118
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3004232000
—
WV
Enumeration date
09/23/2005
Last updated
07/02/2010
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