Provider Demographics
NPI:1932424769
Name:SILVA, PHILLIP EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:EDWARD
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 1:1341 W MOCKINGBIRD LN STE 600W
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-6904
Mailing Address - Country:US
Mailing Address - Phone:214-531-7813
Mailing Address - Fax:214-241-4804
Practice Address - Street 1:1341 W MOCKINGBIRD LN STE 600W
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-6904
Practice Address - Country:US
Practice Address - Phone:214-531-7813
Practice Address - Fax:214-241-4804
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7037207QG0300X, 207QG0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX331671301Medicaid
TX338210YQNLMedicare PIN