MEDICARE: LORI ELIZABETH SYDES R.D., L.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DT06798	TX

General Provider Information

NPI Number	:	1871575001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI ELIZABETH SYDES R.D., L.D.

Provider Business Mailing Address
First Line	:	WILLIAM BEAUMONT ARMY MEDICAL CENTER 5005 N. PIEDRAS ST
Second Line	:	ATTN: CREDENTIALS
City	:	EL PASO
State	:	TX
Zip	:	79920-5001
Country	:	US
Telephone Number	:	915-569-1233
Fax Number	:

Provider Business Practice Location Address
First Line	:	WILLIAM BEAUMONT ARMY MEDICAL CENTER 5005 N. PIEDRAS ST
Second Line	:	ATTN: CREDENTIALS
City	:	EL PASO
State	:	TX
Zip	:	79920-5001
Country	:	US
Telephone Number	:	915-569-1233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	07/08/2007

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