1528495462 NPI number — ERIC SIDES, MD., PA

Table of content: (NPI 1528495462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528495462 NPI number — ERIC SIDES, MD., PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERIC SIDES, MD., PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528495462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7430 REMCON CIR
Provider Second Line Business Mailing Address:
B-110
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79912-3514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-544-2455
Provider Business Mailing Address Fax Number:
915-544-3149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 GEORGE DIETER DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79936-7653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-581-0712
Provider Business Practice Location Address Fax Number:
915-833-7312
Provider Enumeration Date:
10/10/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SIDES
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
915-581-0712

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  J2331 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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