Provider Demographics
NPI:1053592824
Name:SILVA, FRED GEORGE II (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:GEORGE
Last Name:SILVA
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10810 EXECUTIVE CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4386
Mailing Address - Country:US
Mailing Address - Phone:501-604-2695
Mailing Address - Fax:501-604-2699
Practice Address - Street 1:10810 EXECUTIVE CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4386
Practice Address - Country:US
Practice Address - Phone:501-604-2695
Practice Address - Fax:501-604-2699
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047025207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA047025OtherSTATE OF GA MED. LICENSE
ARE-6813OtherMEDICAL LICENSE