Provider Demographics
NPI:1003041484
Name:SIDES, KATHERINE ALISON (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ALISON
Last Name:SIDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 GOODRICH AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4087
Mailing Address - Country:US
Mailing Address - Phone:217-840-6585
Mailing Address - Fax:
Practice Address - Street 1:1301 WONDER WORLD DR
Practice Address - Street 2:CENTRAL TEXAS MEDICAL CENTER
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7533
Practice Address - Country:US
Practice Address - Phone:512-353-8979
Practice Address - Fax:512-753-3698
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC157074390200000X
TXP1925207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program