Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | ME0070922 | FL |
NPI | 1073514253 |
---|---|
Provider Name | Dr. Scott Ian Silas |
First Address | Daytona Beach, FL 32117-4547 |
Second Address | Daytona Beach, FL 32117-4547 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 25/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
250491000 | (05) | FL |
31655Z | PTAN (01) | FL |
G35555 | (02) | FL |