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Individual
MATTHEW JAY SIDEMAN
Active
Individual
MATTHEW JAY SIDEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
N4100
TX
2086S0129X
Vascular Surgery Physician
Primary
N4100
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100845890B
—
OK
05
—
201386401
—
TX
01
—
201386402
CSHCN
TX
01
—
8BX924
BCBS
TX
Enumeration date
01/26/2006
Last updated
12/02/2021
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