Provider Demographics
NPI:1760552277
Name:CIBES-SILVA, MARISTELA (MD)
Entity Type:Individual
Prefix:
First Name:MARISTELA
Middle Name:
Last Name:CIBES-SILVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5112 W GORE BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6003
Mailing Address - Country:US
Mailing Address - Phone:580-699-3900
Mailing Address - Fax:580-699-3901
Practice Address - Street 1:5112 W GORE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6003
Practice Address - Country:US
Practice Address - Phone:580-699-3900
Practice Address - Fax:580-699-3901
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19608207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE50976Medicare UPIN