Provider Demographics
NPI:1578705828
Name:SYDOW, EDWARD ALLEN (PA)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ALLEN
Last Name:SYDOW
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337
Mailing Address - Country:US
Mailing Address - Phone:308-432-4441
Mailing Address - Fax:308-432-2130
Practice Address - Street 1:825 CENTENNIAL DRIVE
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337
Practice Address - Country:US
Practice Address - Phone:308-432-4441
Practice Address - Fax:308-432-2130
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1610363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant