Healthcare Provider Details

I. General information

NPI: 1609483767
Provider Name (Legal Business Name): ERIC SIDES, M.D., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
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: 915-833-7312
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: ERIC EVERETT SIDES
Title or Position: OWNER
Credential: MD
Phone: 915-581-0712