Provider Demographics
NPI:1508068487
Name:DE MELO, SILVIO WANDERLEY JR (MD)
Entity Type:Individual
Prefix:
First Name:SILVIO
Middle Name:WANDERLEY
Last Name:DE MELO
Suffix:JR
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 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-8577
Mailing Address - Fax:503-494-7556
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-494-8577
Practice Address - Fax:503-494-7556
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1396207RG0100X
AL29534207RG0100X
FLME121074207RG0100X
ORMD185874207RG0100X
FLME104528207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DS775OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX283734YKXJMedicare PIN