Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | K5503 | TX |
Y | 111NI0900X | Internist | K5503 | TX |
N | 208000000X | Pediatrician | K5503 | TX |
NPI | 1003806431 |
---|---|
Provider Name | Dr. Glenn R Davis |
First Address | Spring, TX 77389-1812 |
Second Address | Spring, TX 77389-1812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 11/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110240334 | MEDICARE RAILROAD PIN (01) | TX |
H36595 | (02) | TX |