Healthcare Provider Details

I. General information

NPI: 1629229836
Provider Name (Legal Business Name): DOUGLAS RYAN SIDELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DOUG RYAN SIDELL MD

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 WELCH RD
PALO ALTO CA
94304-1601
US

IV. Provider business mailing address

725 WELCH RD
PALO ALTO CA
94304-1601
US

V. Phone/Fax

Practice location:
  • Phone: 650-497-8000
  • Fax:
Mailing address:
  • Phone: 650-497-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberA107296
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA107296
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: