Individual
GLENN MONROE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4920 NE STALLINGS DR, NACOGDOCHES, TX 75965-1254
(936) 569-9481
Mailing address
PO BOX 2887, PORT ARTHUR, TX 77643-2887
(800) 945-2455
(903) 453-2541
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
E6317
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
132172109
—
TX
Enumeration date
04/17/2006
Last updated
12/01/2009
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