Healthcare Provider Details

I. General information

NPI: 1225081359
Provider Name (Legal Business Name): JOSE A. SILVA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 SOUTHPOINT PKWY STE 802
JACKSONVILLE FL
32216-6292
US

IV. Provider business mailing address

6817 SOUTHPOINT PKWY STE 802
JACKSONVILLE FL
32216-6292
US

V. Phone/Fax

Practice location:
  • Phone: 904-422-8038
  • Fax:
Mailing address:
  • Phone: 904-450-6014
  • Fax: 904-450-6015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME 84579
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: