Provider Demographics
NPI:1356347702
Name:DAVENPORT, CHRISTOPHER VERNON (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:VERNON
Last Name:DAVENPORT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 PALMOLA ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-2242
Mailing Address - Country:US
Mailing Address - Phone:863-646-9600
Mailing Address - Fax:330-422-6245
Practice Address - Street 1:207 PALMOLA ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-2242
Practice Address - Country:US
Practice Address - Phone:863-646-9600
Practice Address - Fax:330-422-6245
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME875962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268435700Medicaid
FL268435700Medicaid
FLE89307Medicare UPIN
FL12381YMedicare PIN