Individual
ROBERT ALAN DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 N EAGLE CREEK DR, LEXINGTON, KY 40509-1805
(859) 258-5107
(859) 258-5177
Mailing address
100 N EAGLE CREEK DR, LEXINGTON, KY 40509-1805
(859) 258-5107
(859) 258-5177
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22097
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37903705
MEDICAID LAB GRP
KY
01
—
4000501
MEDICARE LAB NUMBER
KY
05
—
64220973
—
KY
01
—
CB5773
RR MEDICARE GRP
GA
Enumeration date
07/10/2006
Last updated
11/02/2007
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