Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | DR.0062446 | CO |
NPI | 1023374006 |
---|---|
Provider Name | Dr. Michael Thomas Davenport |
First Address | Denver, CO 80247-1314 |
Second Address | Denver, CO 80205-5437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2012 |
Last Update Date | 29/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
029082 | KAISER COMMERCIAL NUMBER (01) | CO |
9000174722 | (05) | CO |