Provider Demographics
NPI:1841358975
Name:SIDNEY, DAVID CLAUDE (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CLAUDE
Last Name:SIDNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:122 CALISTOGA ROAD #396
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-3702
Mailing Address - Country:US
Mailing Address - Phone:707-525-8296
Mailing Address - Fax:707-942-1598
Practice Address - Street 1:122 CALISTOGA ROAD #396
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-3702
Practice Address - Country:US
Practice Address - Phone:707-525-8296
Practice Address - Fax:707-942-1598
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA84341207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A843410Medicaid
CA00A843410Medicaid
H68484Medicare UPIN
H68484Medicare UPIN