Provider Demographics
NPI:1598545360
Name:DAVENPORT, COLIN DEANE
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:DEANE
Last Name:DAVENPORT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11150 LANTERN RD APT 319
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2340
Mailing Address - Country:US
Mailing Address - Phone:317-446-9383
Mailing Address - Fax:
Practice Address - Street 1:429 E VERMONT ST STE 110
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3685
Practice Address - Country:US
Practice Address - Phone:317-559-0850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71016312A207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine