Provider Demographics
NPI:1275587578
Name:SIDES, JAMES A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:SIDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 S SOUDER AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1548
Mailing Address - Country:US
Mailing Address - Phone:614-221-3777
Mailing Address - Fax:614-221-3038
Practice Address - Street 1:51 S SOUDER AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1548
Practice Address - Country:US
Practice Address - Phone:614-221-3777
Practice Address - Fax:614-221-3038
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35. 047683207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0624622Medicaid
OHA16437Medicare UPIN
OH0624622Medicaid