Individual
MR. DARREL SIDES
Active
Individual
MR. DARREL SIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSA
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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