Healthcare Provider Details

I. General information

NPI: 1922088822
Provider Name (Legal Business Name): ERIC E. SIDES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
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 NumberJ2331
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: