Davenport, Derek Joseph

Davenport, Derek Joseph is an individual health care provider with primary practice located at 4095 E Pony Express Pkwy Ste 1 , Eagle Mountain UT 84005-5531. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is his primary health care specialty. Davenport, Derek Joseph can be contacted via phone (801) 429-8037.

Contact Information

Primary practice address
4095 E Pony Express Pkwy Ste 1 Eagle Mountain UT 84005-5531
Phone: (801) 429-8037
Fax: (801) 753-7476
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 11327523-1205 Utah
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X MD162235 Oregon
Allopathic & Osteopathic Physicians / Pediatrics 208000000X MD162235 Oregon
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 11327523-1205 Utah

Profile Details

NPI number 1346484581
LBN Legal business name Davenport, Derek Joseph
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 30th, 2009
Last updated Nov 27th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346484581 NPPES
Other 1346484581 NPI
MEDICAID 500659989 NPI

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