Healthcare Provider Details

I. General information

NPI: 1760891790
Provider Name (Legal Business Name): RICHARD SILVERMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 KINGSLEY AVE
ORANGE PARK FL
32073-4442
US

IV. Provider business mailing address

1990 KINGSLEY AVE
ORANGE PARK FL
32073-4442
US

V. Phone/Fax

Practice location:
  • Phone: 904-213-9350
  • Fax: 904-264-0136
Mailing address:
  • Phone: 904-213-9350
  • Fax: 904-264-0136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS2558
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: