Provider Demographics
NPI:1477581619
Name:DAVIES, MARK GLYNN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:GLYNN
Last Name:DAVIES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-358-2074
Mailing Address - Fax:
Practice Address - Street 1:6600 FISH POND RD STE 101
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2582
Practice Address - Country:US
Practice Address - Phone:254-776-3188
Practice Address - Fax:254-776-3671
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM86202086S0129X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AP706OtherBLUE CROSS BLUE SHIELD
LA1807532Medicaid
TXP01039325OtherRR MEDICARE
TX196915602Medicaid
NY01995142Medicaid
TX196915603Medicaid
TXP00633958OtherRAILROAD MEDICARE
TX196915601Medicaid
TXP00633958OtherRAILROAD MEDICARE
H04488Medicare UPIN
TX196915601Medicaid
TX8AP706OtherBLUE CROSS BLUE SHIELD
TXTXB145268Medicare PIN
8K8761Medicare PIN