Provider Demographics
NPI:1518966274
Name:BIDNER, SANDY M (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDY
Middle Name:M
Last Name:BIDNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SANDY
Other - Middle Name:M
Other - Last Name:BIDNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:800-994-0371
Mailing Address - Fax:
Practice Address - Street 1:2405 S CLEAR CREEK RD
Practice Address - Street 2:SUITE 290
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-5775
Practice Address - Country:US
Practice Address - Phone:254-618-1555
Practice Address - Fax:254-618-1566
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1192207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200035671OtherMEDICARE RAILROAD
TX128293104Medicaid
TXCF8743OtherRAILROAD MEDICARE GROUP
TX82740XOtherBC/BS
TX128293104Medicaid
TX82740XOtherBC/BS