MEDICARE: DR. RICHARD J SIDD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	84260	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	NM84260	OTHER		NM LICENSE

General Provider Information

NPI Number	:	1205998788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD J SIDD MD

Provider Business Mailing Address
First Line	:	207 N UNION
Second Line	:	SUITE C
City	:	ROSWELL
State	:	NM
Zip	:	88201-3068
Country	:	US
Telephone Number	:	505-622-7295
Fax Number	:	505-622-6509

Provider Business Practice Location Address
First Line	:	207 N UNION AVE STE C
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88201-3068
Country	:	US
Telephone Number	:	575-622-7295
Fax Number	:	575-622-7295

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	10/17/2018

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Directions to “ DR. RICHARD J SIDD MD” Practice Location

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