Individual
DOUGLAS MITCHELL SIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
688 KINOOLE ST, SUITE 103, HILO, HI 96720
(808) 935-1825
(903) 663-7394
Mailing address
PO BOX 30077, SALT LAKE CITY, UT 84130-0077
(702) 477-0772
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
10716
NV
2085R0202X
Diagnostic Radiology Physician
G76456
CA
2085R0204X
Vascular & Interventional Radiology Physician
G76456
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100502411
—
NV
05
—
905838
—
AZ
01
—
CC5535
BLUE
NV
Enumeration date
07/12/2005
Last updated
11/08/2018
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