Glen F. Davis, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME37813 Issued in FL

Practice address

4106 W Lake Mary Blvd
Suite 301
Lake Mary, FL 32746-3315

Phone

(407) 333-2503

NPI assigned

Jun 14, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Florida Internal Medicine PA

  • Internal Medicine Physician
  • Lake Mary, FL
  • NPI 1831136274
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187568000000",
    "number": "1689617813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4106 W LAKE MARY BLVD",
            "address_2": "SUITE 301",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463315",
            "telephone_number": "407-333-2503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4106 W LAKE MARY BLVD",
            "address_2": "SUITE 301",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463315",
            "telephone_number": "407-333-2503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "GLEN",
        "middle_name": "F.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2007-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME37813",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mackenzie Davidson
• Melissa Anne Davidson, RN, BSN
• Andrea Gloria Davila
• Michael Joseph Davila, HAS
• Elaina Chavonta Davis
• Kiandra Davis
• Mathieu Davis Jr.
• Raedawn O Davis
• Sara Dawit
• Ian Richard Day, M.D.

• Internal Medicine Physician in Lake Mary, FL
• Providers in Lake Mary, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.