Provider Demographics
NPI:1134321540
Name:DAVENPORT, DREW MARK (DO)
Entity Type:Individual
Prefix:DR
First Name:DREW
Middle Name:MARK
Last Name:DAVENPORT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12874 W DOVE WING WAY
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2491
Mailing Address - Country:US
Mailing Address - Phone:440-864-7374
Mailing Address - Fax:
Practice Address - Street 1:12874 W DOVE WING WAY
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-2491
Practice Address - Country:US
Practice Address - Phone:440-864-7374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4679207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology