Basic Information
| Provider Information | |||||||||
| NPI: | 1679528541 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIDES | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 16TH ST | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806315114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703480020 | ||||||||
| FaxNumber: | 9703480055 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 16TH ST | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806315114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703480020 | ||||||||
| FaxNumber: | 9703480055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 02/21/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 44678 | CO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0004X | 44678 | CO | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 20539266 | 05 | CO | MEDICAID |