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General NPI Number Information
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NPI Number | 1083724512
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Entity Type | Individual
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Provider Name | GLENN DAVIS MD
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 10/11/2013
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Provider Practice Location Address
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Address Line | 1510 BOB WHITE BLVD
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City | PULASKI
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State | VA
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Zip | 24301-4406
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Country | US
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Telephone | 540-980-1965
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Fax | 540-980-0032
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Provider Business Mailing Address
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Address Line | 1510 BOB WHITE BLVD
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City | PULASKI
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State | VA
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Zip | 24301-4406
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Country | US
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Telephone | 540-980-1965
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Fax | 540-980-0032
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 0101036189
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License Number State | VA
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