Provider Demographics
NPI:1699836767
Name:LOUIS F GREGORY AND R GLENN DAVIS
Entity Type:Organization
Organization Name:LOUIS F GREGORY AND R GLENN DAVIS
Other - Org Name:GREGORY AND DAVIS MDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-398-8266
Mailing Address - Street 1:3129 HENDRICKS AVENUE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-4217
Mailing Address - Country:US
Mailing Address - Phone:904-398-8266
Mailing Address - Fax:904-396-4803
Practice Address - Street 1:3129 HENDRICKS AVENUE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4217
Practice Address - Country:US
Practice Address - Phone:904-398-8266
Practice Address - Fax:904-396-4803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K0699Medicare ID - Type Unspecified