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Individual
DR. AVERY LYNE SIDES
Active
Individual
DR. AVERY LYNE SIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1481
SD
207Q00000X
Family Medicine Physician
6455
NE
Other
Enumeration date
05/12/2011
Last updated
03/23/2015
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