Provider Demographics
NPI:1205161569
Name:SIDNEY, COY BENTRY
Entity type:Individual
Prefix:MR
First Name:COY
Middle Name:BENTRY
Last Name:SIDNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 CRESCENT BRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-1685
Mailing Address - Country:US
Mailing Address - Phone:713-530-0935
Mailing Address - Fax:281-459-3386
Practice Address - Street 1:7310 CRESCENT BRIDGE CT
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-1685
Practice Address - Country:US
Practice Address - Phone:713-530-0935
Practice Address - Fax:281-459-3386
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator