Healthcare Provider Details

I. General information

NPI: 1205881034
Provider Name (Legal Business Name): ROBERT JOHN SILVY II CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W WRANGLER BLVD
SEMINOLE OK
74868-1917
US

IV. Provider business mailing address

2401 W WRANGLER BLVD
SEMINOLE OK
74868-1917
US

V. Phone/Fax

Practice location:
  • Phone: 405-303-4050
  • Fax: 405-303-4150
Mailing address:
  • Phone: 405-303-4050
  • Fax: 405-303-4150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number25937
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: