| Dr Terry Evert Davenport, DO | |
|
229 S 8th St, St Maries, ID 83861-1813 | |
| (208) 245-2591 | |
| (208) 245-5246 |
| Full Name | Dr Terry Evert Davenport |
|---|---|
| Gender | Male |
| Speciality | Family Medicine |
| Location | 229 S 8th St, St Maries, Idaho |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710974191 | NPI | - | NPPES |
| 601415700 | Other | DEEIOC | |
| S1303 | Other | ID | BLUE CROSS OF ID |
| 123363 | Other | WA | DEPT OF LABOR&INDUSTRIES |
| 8434839 | Medicaid | WA | |
| 805169900 | Medicaid | ID | |
| 000010004699 | Other | ID | REGENCE BS OF ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208M00000X | Hospitalist | O-130 (Idaho) | Secondary |
| 207Q00000X | Family Medicine | O-130 (Idaho) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Terry Evert Davenport, DO 229 S 8th St, St Maries, ID 83861-1813 Ph: (208) 245-2591 | Dr Terry Evert Davenport, DO 229 S 8th St, St Maries, ID 83861-1813 Ph: (208) 245-2591 |
Karen D Libsch, MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 229 S 8th St, St Maries, ID 83861 Phone: 208-245-2591 Fax: 208-245-5246 |