Provider Demographics
NPI:1528495462
Name:ERIC SIDES, MD., PA
Entity type:Organization
Organization Name:ERIC SIDES, MD., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-581-0712
Mailing Address - Street 1:7430 REMCON CIR
Mailing Address - Street 2:B-110
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3514
Mailing Address - Country:US
Mailing Address - Phone:915-544-2455
Mailing Address - Fax:915-544-3149
Practice Address - Street 1:1400 GEORGE DIETER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7653
Practice Address - Country:US
Practice Address - Phone:915-581-0712
Practice Address - Fax:915-833-7312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2331207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty