Individual
CHARLES J DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
512 NOKOMIS AVE S, VENICE, FL 34285-2817
(941) 488-7781
(941) 486-8991
Mailing address
PO BOX 1508, VENICE, FL 34284-1508
(941) 488-7781
(941) 484-9235
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME60801
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
262992500
—
FL
Enumeration date
06/26/2006
Last updated
09/09/2011
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