Healthcare Provider Details

I. General information

NPI: 1720006323
Provider Name (Legal Business Name): ENRIQUE MANUEL SILVA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4972 TOWN CENTER PKWY STE 301
JACKSONVILLE FL
32246-8595
US

IV. Provider business mailing address

900 S PINE ISLAND RD SUITE 800
PLANTATION FL
33324-3920
US

V. Phone/Fax

Practice location:
  • Phone: 904-642-6100
  • Fax: 904-642-5154
Mailing address:
  • Phone: 904-642-6100
  • Fax: 904-642-5154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME44830
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: