Basic Information
| Provider Information | |||||||||
| NPI: | 1134395973 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVENPORT | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 316 SAWYER DR | ||||||||
| Address2: | |||||||||
| City: | DURANGO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813036560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703755840 | ||||||||
| FaxNumber: | 9702596605 | ||||||||
| Practice Location | |||||||||
| Address1: | 706 AVE G | ||||||||
| Address2: | |||||||||
| City: | MARBLE FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786545866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8306938234 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2008 | ||||||||
| LastUpdateDate: | 10/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | M5681 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.