Individual
KENNETH K DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1026 GOODYEAR AVE STE 302B, GADSDEN, AL 35903-1194
(256) 485-0899
(866) 265-9563
Mailing address
1026 GOODYEAR AVE STE 302B, GADSDEN, AL 35903-1194
(256) 485-0899
(866) 265-9563
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
29230
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130499
—
AL
01
—
511-17039
BLUE CROSS BLUE SHIELD ALABAMA
AL
05
—
529203130
—
AL
01
—
D570
MEDICARE GROUP NUMBER
AL
Enumeration date
11/19/2007
Last updated
12/31/2024
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