MEDICARE: MARSHALL BRUCE SILK D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	OS6517	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902852486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHALL BRUCE SILK D.O.

Provider Business Mailing Address
First Line	:	1314 E LAS OLAS BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33301-2334
Country	:	US
Telephone Number	:	954-525-7068
Fax Number	:	305-547-6469

Provider Business Practice Location Address
First Line	:	1690 S CONGRESS AVE STE 205B
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-6327
Country	:	US
Telephone Number	:	561-459-7300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	09/13/2022

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