Healthcare Provider Details

I. General information

NPI: 1801899141
Provider Name (Legal Business Name): RALPH SILVERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12345 WEST BEND DR. SUITE 303
ST. LOUIS MO
63128
US

IV. Provider business mailing address

12345 WEST BEND DRIVE SUITE 303
ST. LOUIS MO
63128
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-1811
  • Fax: 314-849-7470
Mailing address:
  • Phone: 314-849-1811
  • Fax: 314-849-7470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number115610
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberMD115610
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: