MEDICARE: DR. MARK GLYNN DAVIES M.D.

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	2086S0129X	Vascular Surgery Physician	M8620	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01039325	OTHER	TX	RR MEDICARE
7	P00633958	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8AP706	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477581619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK GLYNN DAVIES M.D.

Provider Business Mailing Address
First Line	:	7703 FLOYD CURL DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3901
Country	:	US
Telephone Number	:	210-358-2074
Fax Number	:

Provider Business Practice Location Address
First Line	:	6600 FISH POND RD STE 101
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76710-2582
Country	:	US
Telephone Number	:	254-776-3188
Fax Number	:	254-776-3671

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	09/13/2023

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Directions to “ DR. MARK GLYNN DAVIES M.D.” Practice Location

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