Healthcare Provider Details

I. General information

NPI: 1528495462
Provider Name (Legal Business Name): ERIC SIDES, MD., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2013
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 GEORGE DIETER DR SUITE 100
EL PASO TX
79936-7653
US

IV. Provider business mailing address

7430 REMCON CIR B-110
EL PASO TX
79912-3514
US

V. Phone/Fax

Practice location:
  • Phone: 915-581-0712
  • Fax: 915-833-7312
Mailing address:
  • Phone: 915-544-2455
  • Fax: 915-544-3149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberJ2331
License Number StateTX

VIII. Authorized Official

Name: DR. ERIC E SIDES
Title or Position: OWNER
Credential: MD
Phone: 915-581-0712