Provider Demographics
NPI:1669851747
Name:WHITESIDES, STEPHEN P (AA-C)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:P
Last Name:WHITESIDES
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Gender:M
Credentials:AA-C
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Mailing Address - Street 1:339 CONSORT DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4439
Mailing Address - Country:US
Mailing Address - Phone:636-386-9224
Mailing Address - Fax:636-200-4243
Practice Address - Street 1:615 S NEW BALLAS RD
Practice Address - Street 2:DEPT. OF ANESTHESIA
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8221
Practice Address - Country:US
Practice Address - Phone:636-386-9224
Practice Address - Fax:636-200-4243
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2015-10-08
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Provider Licenses
StateLicense IDTaxonomies
MO2015034271367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant