| Christopher Davenport Md Mba Pa | |
|
207 Palmola St Lakeland FL 33803-2242 | |
| (863) 646-9600 | |
| (330) 422-6245 |
| Full Name | Christopher Davenport Md Mba Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 207 Palmola St, Lakeland, Florida |
| Authorized Official Name and Position | Christopher Vernon Davenport (PRESIDENT) |
| Authorized Official Contact | 8636469600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Christopher Davenport Md Mba Pa 207 Palmola St Lakeland FL 33803-2242 Ph: (863) 646-9600 | Christopher Davenport Md Mba Pa 207 Palmola St Lakeland FL 33803-2242 Ph: (863) 646-9600 |
| NPI Number | 1528238201 |
|---|---|
| Provider Enumeration Date | 03/10/2008 |
| Last Update Date | 11/24/2020 |
| Certification Date | 11/24/2020 |
| Medicare PECOS PAC ID | 8022912294 |
|---|---|
| Medicare Enrollment ID | O20031120000652 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528238201 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | ME0087596 (Florida) | Primary |
| Provider Name | Christopher V Davenport |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356347702 PECOS PAC ID: 7315841483 Enrollment ID: I20031126000015 |
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