Organization
SIDAROUS, LLC
Active
Other names
The Rock Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER SIDAROUS MD (OWNER)
(717) 319-9672
Entity
Organization
Contact information
Practice address
11521 W MARKHAM ST, LITTLE ROCK, AR 72211-2701
(501) 502-2765
(501) 302-1991
Mailing address
11521 W MARKHAM ST, LITTLE ROCK, AR 72211-2701
(501) 502-2765
(501) 302-1991
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E100-91
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
219215001
—
AR
Enumeration date
06/12/2018
Last updated
11/13/2024
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