Healthcare Provider Details

I. General information

NPI: 1487917811
Provider Name (Legal Business Name): PAUL DANIEL SILVERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MCLAIN ST STE G
NEWPORT AR
72112-3550
US

IV. Provider business mailing address

1200 MCLAIN ST STE G
NEWPORT AR
72112-3550
US

V. Phone/Fax

Practice location:
  • Phone: 870-523-0193
  • Fax: 870-523-3583
Mailing address:
  • Phone: 870-523-0193
  • Fax: 870-523-3583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD21914
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-8375
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: