Provider Demographics
NPI:1801836119
Name:SILVA, BRUCE E (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:E
Last Name:SILVA
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 1:2424 N. WYATT DRIVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712
Mailing Address - Country:US
Mailing Address - Phone:520-545-0608
Mailing Address - Fax:520-795-0354
Practice Address - Street 1:174 S CORONADO DR STE A
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-6356
Practice Address - Country:US
Practice Address - Phone:520-545-0676
Practice Address - Fax:520-547-2993
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16798207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2Z2272OtherHN
AZ270653Medicaid
AZ0119590OtherBCBSAZ
105252Medicare ID - Type Unspecified
C46578Medicare UPIN
AZA104696Medicare PIN
AZ0119590OtherBCBSAZ