Individual
WILLIAM J DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1500 E SHERMAN BLVD, MUSKEGON, MI 49444-1849
(231) 672-3883
(231) 672-3973
Mailing address
PO BOX 1847, MUSKEGON, MI 49443-1847
(231) 727-4444
(231) 727-4451
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
0110001951
VA
363AM0700X
Medical Physician Assistant
Primary
5601005653
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0N27530065
MEDICARE
MI
Enumeration date
07/07/2006
Last updated
08/20/2012
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