MEDICARE: DR. GLENN R DAVIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	38899	OK
2	208000000X	Pediatrics Physician	K5503	TX
3	207R00000X	Internal Medicine Physician	K5503	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110240334	OTHER	TX	MEDICARE RAILROAD PIN

General Provider Information

NPI Number	:	1003806431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN R DAVIS MD

Provider Business Mailing Address
First Line	:	2255 E MOSSY OAKS RD STE 680
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77389-1812
Country	:	US
Telephone Number	:	281-537-0300
Fax Number	:	281-537-0315

Provider Business Practice Location Address
First Line	:	2255 E MOSSY OAKS RD STE 680
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77389-1812
Country	:	US
Telephone Number	:	281-537-0300
Fax Number	:	281-537-0315

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	10/17/2022

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Directions to “ DR. GLENN R DAVIS MD” Practice Location

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