Provider Demographics
NPI:1952309791
Name:SIDES, GARY W (DO)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:W
Last Name:SIDES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1216 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-1654
Mailing Address - Country:US
Mailing Address - Phone:636-543-7600
Mailing Address - Fax:636-543-7606
Practice Address - Street 1:1216 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-1654
Practice Address - Country:US
Practice Address - Phone:636-937-3611
Practice Address - Fax:636-937-3612
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR1B61207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine