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General NPI Number Information
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NPI Number | 1477581619
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Entity Type | Individual
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Provider Name | MARK GLYNN DAVIES M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 6600 FISH POND RD STE 101
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City | WACO
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State | TX
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Zip | 76710-2582
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Country | US
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Telephone | 254-776-3188
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Fax | 254-776-3671
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Provider Business Mailing Address
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Address Line | 7703 FLOYD CURL DR
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3901
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Country | US
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Telephone | 210-358-2074
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Fax |
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | M8620
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License Number State | TX
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