Basic Information
| Provider Information | |||||||||
| NPI: | 1821028408 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SILVERBERG | ||||||||
| FirstName: | DEAN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | NORTH FLORIDA/SOUTH GEORGIA VETERANS HEALTH SYSTEM | ||||||||
| Address2: | 619 SOUTH MARION AVENUE | ||||||||
| City: | LAKE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867553016 | ||||||||
| FaxNumber: | 3867586008 | ||||||||
| Practice Location | |||||||||
| Address1: | NORTH FLORIDA/SOUTH GEORGIA VETERANS HEALTH SYSTEM | ||||||||
| Address2: | 619 SOUTH MARION AVENUE | ||||||||
| City: | LAKE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867553016 | ||||||||
| FaxNumber: | 3867586008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 10/26/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | OS5504 | FL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000784803G | 05 | GA | MEDICAID | 005276 | 01 | GA | BLUE CROSS | OTHER |