Provider Demographics
NPI:1508868001
Name:DUNCAN, SILAS EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SILAS
Middle Name:EDWIN
Last Name:DUNCAN
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 1:700 OLYMPIC PLAZA CIR
Mailing Address - Street 2:SUITE 510
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1951
Mailing Address - Country:US
Mailing Address - Phone:903-595-2636
Mailing Address - Fax:903-595-5560
Practice Address - Street 1:700 OLYMPIC PLAZA CIR
Practice Address - Street 2:SUITE 510
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1951
Practice Address - Country:US
Practice Address - Phone:903-595-2636
Practice Address - Fax:903-595-5560
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4981208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMDD4981OtherTX WC/IHC
TX020028080OtherRAILROAD MEDICARE
TX2287588OtherBLUELINK
TX123940201Medicaid
TX4568289OtherAETNA
TX752605101OtherFEIN
TX752605101OtherFEIN
TX86Z400Medicare ID - Type Unspecified