Individual
JAKE SIDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 MEDICAL PARK BLVD STE 250W, BRISTOL, TN 37620-7431
(423) 844-6620
(423) 844-6626
Mailing address
1021 W OAKLAND AVE STE 310, JOHNSON CITY, TN 37604-2192
(423) 302-6565
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
0101275797
VA
208600000X
Surgery Physician
Primary
63286
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/31/2016
Last updated
07/03/2024
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