Provider Demographics
NPI:1972672194
Name:SIDES, EVIN HENDERSON III (MD)
Entity Type:Individual
Prefix:DR
First Name:EVIN
Middle Name:HENDERSON
Last Name:SIDES
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1932 BRASSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-9450
Mailing Address - Country:US
Mailing Address - Phone:919-847-9592
Mailing Address - Fax:919-481-5707
Practice Address - Street 1:200 PERIMETER PARK DR
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-9714
Practice Address - Country:US
Practice Address - Phone:919-481-5742
Practice Address - Fax:919-481-5707
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC14767207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC80581Medicare UPIN