Provider Demographics
NPI:1063458040
Name:SILVOSO, GERALD R (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:R
Last Name:SILVOSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 LILE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6217
Mailing Address - Country:US
Mailing Address - Phone:501-227-8000
Mailing Address - Fax:501-221-5850
Practice Address - Street 1:10001 LILE DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6217
Practice Address - Country:US
Practice Address - Phone:501-227-8000
Practice Address - Fax:501-221-5850
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN5642207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104771001Medicaid
AR54850Medicare ID - Type Unspecified
AR104771001Medicaid