Provider Demographics
NPI:1093432643
Name:SILVER, DEREK (PA-C)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:SILVER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3524 AIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4701
Mailing Address - Country:US
Mailing Address - Phone:719-526-1910
Mailing Address - Fax:
Practice Address - Street 1:3524 AIRFIELD RD
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4701
Practice Address - Country:US
Practice Address - Phone:719-526-1910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant