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General NPI Number Information
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NPI Number | 1619957388
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Entity Type | Individual
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Provider Name | SIDNEY B. BELSHE M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 03/04/2009
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Provider Practice Location Address
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Address Line | 1241 W STADIUM BLVD
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City | JEFFERSON CITY
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State | MO
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Zip | 65109-6023
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Country | US
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Telephone | 573-556-7755
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Fax | 573-761-3599
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Provider Business Mailing Address
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Address Line | PO BOX 104240
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City | JEFFERSON CITY
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State | MO
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Zip | 65110-4240
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Country | US
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Telephone | 573-556-5191
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Fax | 573-761-3599
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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 | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number | R8A86
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | R8A86
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | R8A86
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License Number State | MO
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