Healthcare Provider Details

I. General information

NPI: 1093194425
Provider Name (Legal Business Name): SILAS KLAVER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 UNSER BLVD SE STE 8100
RIO RANCHO NM
87124-4740
US

IV. Provider business mailing address

3800 SUMMITVIEW AVE
YAKIMA WA
98902-2715
US

V. Phone/Fax

Practice location:
  • Phone: 505-253-6100
  • Fax:
Mailing address:
  • Phone: 509-248-7849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberT-1555
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD434
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: