Provider Demographics
NPI:1568492122
Name:SILVERS, BRENT EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:EDWARD
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 1:2 HUGHES
Mailing Address - Street 2:STE 150
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2036
Mailing Address - Country:US
Mailing Address - Phone:949-770-1122
Mailing Address - Fax:949-770-9137
Practice Address - Street 1:2 HUGHES
Practice Address - Street 2:SUITE 150
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2056
Practice Address - Country:US
Practice Address - Phone:949-770-1122
Practice Address - Fax:949-770-9137
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49201207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF52353Medicare UPIN
CAWA49201DMedicare ID - Type Unspecified