Provider Demographics
NPI:1578592473
Name:SIDMAN, JENNIFER M (MD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:M
Last Name:SIDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4011 NW 43RD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-4609
Mailing Address - Country:US
Mailing Address - Phone:352-373-0211
Mailing Address - Fax:352-373-0214
Practice Address - Street 1:4011 NW 43RD ST
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-4609
Practice Address - Country:US
Practice Address - Phone:352-373-0211
Practice Address - Fax:352-373-0214
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2022-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME61151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18706OtherBCBS
FLF54802Medicare UPIN
FL18706AMedicare ID - Type Unspecified