Provider Demographics
NPI:1467629337
Name:SILVERS, STACY K (MD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:K
Last Name:SILVERS
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 1:5929 BALCONES DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4280
Mailing Address - Country:US
Mailing Address - Phone:855-845-7777
Mailing Address - Fax:855-828-0878
Practice Address - Street 1:5929 BALCONES DR STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4280
Practice Address - Country:US
Practice Address - Phone:855-845-7777
Practice Address - Fax:855-828-0878
Is Sole Proprietor?:No
Enumeration Date:2008-05-10
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0063215207K00000X
FLME142510207K00000X
AZ63352207K00000X
TXN8461207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX397500ZM3LOtherMEDICARE PTAN
TX397500ZM3JOtherMEDICARE PTAN