Healthcare Provider Details

I. General information

NPI: 1639178114
Provider Name (Legal Business Name): MARK EDWARD SILVER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 OAK ST
BROOKINGS OR
97415-9612
US

IV. Provider business mailing address

PO BOX 5870 446 OAK ST
BROOKINGS OR
97415-0234
US

V. Phone/Fax

Practice location:
  • Phone: 541-469-7401
  • Fax: 541-469-7083
Mailing address:
  • Phone: 541-469-7401
  • Fax: 541-469-7083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number44
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD15808
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: