Provider Demographics
NPI:1386614774
Name:SIDEMAN, MATTHEW JAY (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAY
Last Name:SIDEMAN
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 1:8300 FLOYD CURL DR FL 4
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3931
Mailing Address - Country:US
Mailing Address - Phone:210-450-9888
Mailing Address - Fax:210-450-6041
Practice Address - Street 1:8300 FLOYD CURL DR FL 4
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3931
Practice Address - Country:US
Practice Address - Phone:210-450-9888
Practice Address - Fax:210-450-6041
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN41002086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100845890BMedicaid
TX201386401Medicaid
TX201386402OtherCSHCN
TX8BX924OtherBCBS
TX201386402OtherCSHCN