Provider Demographics
NPI:1124068275
Name:SIDRYS, JONAS VYTAS (MD)
Entity type:Individual
Prefix:
First Name:JONAS
Middle Name:VYTAS
Last Name:SIDRYS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 827
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38503-0827
Mailing Address - Country:US
Mailing Address - Phone:931-783-2497
Mailing Address - Fax:931-783-5757
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4294
Practice Address - Country:US
Practice Address - Phone:931-783-2497
Practice Address - Fax:931-783-5757
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2009-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN393152085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3806863Medicaid
TN3806863Medicaid
TN3806863Medicare ID - Type UnspecifiedMCR