Provider Demographics
NPI:1609483767
Name:ERIC SIDES, M.D., PA
Entity Type:Organization
Organization Name:ERIC SIDES, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:SIDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-581-0712
Mailing Address - Street 1:PO BOX 12793
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79913-0793
Mailing Address - Country:US
Mailing Address - Phone:915-581-0712
Mailing Address - Fax:915-833-7312
Practice Address - Street 1:820 E REDD RD BLDG B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7275
Practice Address - Country:US
Practice Address - Phone:915-581-0712
Practice Address - Fax:915-833-7312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty