Provider Demographics
NPI:1902852486
Name:SILK, MARSHALL BRUCE (DO)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:BRUCE
Last Name:SILK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 E LAS OLAS BLVD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2334
Mailing Address - Country:US
Mailing Address - Phone:954-525-7068
Mailing Address - Fax:305-547-6469
Practice Address - Street 1:1690 S CONGRESS AVE STE 205B
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6327
Practice Address - Country:US
Practice Address - Phone:561-459-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6517207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269560000Medicaid
FLU2655YMedicare ID - Type Unspecified