Organization
GEORGE SIDHOM MD PA
Active
Other names
Brandon Pain Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JEAN SIDHOM (BILLING/OFFICE MANAGER)
(352) 688-6393
Entity
Organization
Contact information
Practice address
722 BOWING OAK DR, BRANDON, FL 33511-5974
(813) 684-7246
(813) 684-0453
Mailing address
PO BOX 10478, BROOKSVILLE, FL 34603-0478
(813) 684-7246
(813) 684-0453
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
97788
BLUE CROSS
—
Enumeration date
09/26/2007
Last updated
04/03/2013
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