Healthcare Provider Details

I. General information

NPI: 1285636779
Provider Name (Legal Business Name): MORRIS MITCHELL SILVER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: M MITCHELL SILVER DO

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4495 FURLING LN SUITE 210
DESTIN FL
32541-5384
US

IV. Provider business mailing address

4495 FURLING LN STE 210
DESTIN FL
32541-5423
US

V. Phone/Fax

Practice location:
  • Phone: 850-460-8483
  • Fax:
Mailing address:
  • Phone: 850-460-8483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberH4704
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberDO37659
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS13791
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberOS13791
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: