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Organization
SILVER FAMILY PRACTICE, INC.
Active
Organization
SILVER FAMILY PRACTICE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL M SILVER DO (PRESIDENT)
(805) 788-0200
Entity
Organization
Contact information
Practice address
77 CASA ST, SUITE 104, SAN LUIS OBISPO, CA 93405-5803
(805) 788-0200
(805) 788-0300
Mailing address
77 CASA ST, SUITE 104, SAN LUIS OBISPO, CA 93405-5803
(805) 788-0200
(805) 788-0300
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
C3219159
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5484078
AETNA PIN
—
01
—
C3219159
STATE CORP #
CA
01
—
ZZZ56109Y
BLUE SHIELD PIN
CA
Enumeration date
09/08/2009
Last updated
03/13/2014
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