Dr. Terry Evert Davenport, DO
Family Medicine in St Maries, ID. Individual provider (NPI-1).
NPI number1710974191
StatusActive
Last updated in NPPESNov 15, 2023
Details
- NPI
- 1710974191
- Entity type
- Individual (NPI-1)
- Name
- Dr. Terry Evert Davenport
- Credential
- DO
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 30, 2005
- Certification date
- Nov 15, 2023
- Last updated
- Nov 15, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | O-130 | ID | Yes |
| 208M00000X | Hospitalist | O-130 | ID |
Practice location
229 S 8th StSt Maries, ID 83861-1813
Phone 208-245-2591 · Fax 208-245-5246
Mailing address
229 S 8th StSt Maries, ID 83861-1813
Phone 208-245-2591 · Fax 208-245-5246
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