Healthcare Provider Details

I. General information

NPI: 1053679464
Provider Name (Legal Business Name): ERIC SIDES, M.D., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 E REDD RD BLDG B
EL PASO TX
79912-7275
US

IV. Provider business mailing address

PO BOX 12793
EL PASO TX
79913-0793
US

V. Phone/Fax

Practice location:
  • Phone: 915-581-0712
  • Fax: 915-533-8680
Mailing address:
  • Phone: 915-581-0712
  • Fax: 915-833-7312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC E. SIDES
Title or Position: CEO
Credential: M.D.
Phone: 915-581-0712