Provider Demographics
NPI:1871302356
Name:DAVENPORT, RICK MERRIMAN II
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:MERRIMAN
Last Name:DAVENPORT
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15622 W 101ST ST S
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-6731
Mailing Address - Country:US
Mailing Address - Phone:918-282-7815
Mailing Address - Fax:
Practice Address - Street 1:15622 W 101ST ST S
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-6731
Practice Address - Country:US
Practice Address - Phone:918-282-7815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist