Individual
MR. DARREL SIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSA
Contact information
Practice address
6271 MARTYS TRAIL, INDEPENDENCE, KY 41051-0583
(859) 816-6684
(859) 356-0682
Mailing address
PO BOX 583, INDEPENDENCE, KY 41051-0583
(859) 816-6684
(859) 356-0682
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
SA109
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000308821
BC
KY
Enumeration date
01/16/2007
Last updated
07/08/2007
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