1336191600 NPI number — BURTON L SILVERMAN MD

Table of content: BURTON L SILVERMAN MD (NPI 1336191600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336191600 NPI number — BURTON L SILVERMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SILVERMAN
Provider First Name:
BURTON
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336191600
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 CENTERPOINTE DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE OSWEGO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97035-8660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-797-2273
Provider Business Mailing Address Fax Number:
503-234-8155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4510 SW HALL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVERTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-644-1171
Provider Business Practice Location Address Fax Number:
503-643-7443
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD19465 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 074299 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080088226 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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