Provider Demographics
NPI:1568499903
Name:SILVERBERG, BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:SILVERBERG
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 1:2727 E 32ND ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3164
Mailing Address - Country:US
Mailing Address - Phone:417-621-9000
Mailing Address - Fax:417-621-9002
Practice Address - Street 1:2727 E 32ND ST
Practice Address - Street 2:SUITE A
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3164
Practice Address - Country:US
Practice Address - Phone:417-621-9000
Practice Address - Fax:417-621-9002
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2A49208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100398450AMedicaid
MO209779917Medicaid
OK100183480AMedicaid
240007316OtherRR MEDICARE
MO110815OtherANTHEM
240007316OtherRR MEDICARE
KS100398450AMedicaid