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General NPI Number Information
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NPI Number | 1124068275
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Entity Type | Individual
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Provider Name | JONAS VYTAS SIDRYS M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 1 MEDICAL CENTER BLVD
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City | COOKEVILLE
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State | TN
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Zip | 38501-4294
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Country | US
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Telephone | 931-783-2497
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Fax | 931-783-5757
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Provider Business Mailing Address
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Address Line | PO BOX 827
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City | COOKEVILLE
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State | TN
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Zip | 38503-0827
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Country | US
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Telephone | 931-783-2497
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Fax | 931-783-5757
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 14416C
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 39315
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License Number State | TN
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