Individual
DR. CHARLES W. DAVENPORT JR.
Active
Individual
DR. CHARLES W. DAVENPORT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
13521
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00115846
—
MS
05
—
009809870
—
AL
01
—
060048292
TRICARE
—
01
—
731-02314
BLUE CROSS OF AL
—
Enumeration date
11/17/2005
Last updated
11/06/2013
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