=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083619639
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM MARK SILVERMAN D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2005
-----------------------------------------------------
Last Update Date | 06/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 590 RUBY CT
-----------------------------------------------------
City | MAITLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32751-5226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-677-4867
-----------------------------------------------------
Fax | 407-677-4203
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 590 RUBY CT
-----------------------------------------------------
City | MAITLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32751-5226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-677-4867
-----------------------------------------------------
Fax | 407-677-4203
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS0003966
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------