Provider Demographics
NPI:1760463053
Name:SILVESTRE, JUSTINO (MD)
Entity Type:Individual
Prefix:
First Name:JUSTINO
Middle Name:
Last Name:SILVESTRE
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:PO BOX 495550
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-5550
Mailing Address - Country:US
Mailing Address - Phone:941-255-9815
Mailing Address - Fax:941-255-9831
Practice Address - Street 1:3524 TAMIAMI TRL
Practice Address - Street 2:SUITE D
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8100
Practice Address - Country:US
Practice Address - Phone:941-255-9815
Practice Address - Fax:941-255-9831
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67570207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252914900Medicaid
FL252914900Medicaid
FL28516ZMedicare PIN