Provider Demographics
NPI:1972896074
Name:DAVENPORT, MAURA (MD)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:MT
Mailing Address - Zip Code:59729-8001
Mailing Address - Country:US
Mailing Address - Phone:406-682-4223
Mailing Address - Fax:406-682-4756
Practice Address - Street 1:305 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:MT
Practice Address - Zip Code:59729-8001
Practice Address - Country:US
Practice Address - Phone:406-682-4223
Practice Address - Fax:406-682-4756
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine