Provider Demographics
NPI:1215255344
Name:SIDES, WILLIAM DEAN (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DEAN
Last Name:SIDES
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 1:1130 22ND ST S STE 1000
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-2881
Mailing Address - Country:US
Mailing Address - Phone:469-893-2065
Mailing Address - Fax:469-893-3065
Practice Address - Street 1:430 FIELDSTOWN RD STE 104
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2485
Practice Address - Country:US
Practice Address - Phone:205-631-5521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC78787Medicare UPIN