Healthcare Provider Details

I. General information

NPI: 1679773402
Provider Name (Legal Business Name): DUSTIN EDWARD SILHAN PR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N HOBART ST STE 2JS
PAMPA TX
79065-4641
US

IV. Provider business mailing address

1201 N HOBART ST STE 2JS
PAMPA TX
79065-4641
US

V. Phone/Fax

Practice location:
  • Phone: 806-665-4820
  • Fax: 806-665-4123
Mailing address:
  • Phone: 806-665-4820
  • Fax: 806-665-4123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1174899
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: