Provider Demographics
NPI:1053364380
Name:DAVENPORT, THOMAS WINCHESTER (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WINCHESTER
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 1:431 NATALIE DR
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-9246
Mailing Address - Country:US
Mailing Address - Phone:971-998-9006
Mailing Address - Fax:
Practice Address - Street 1:431 NATALIE DR
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-9246
Practice Address - Country:US
Practice Address - Phone:971-998-9006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22831207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology