Individual
DR. STEPHEN D. SIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
(573) 635-5264
(573) 761-4351
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
(573) 635-5264
(573) 761-4351
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2001001591
MO
207RR0500X
Rheumatology Physician
Primary
2001001591
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
191077
BCBS
MO
05
—
245300611
—
MO
01
—
461803
HEALTHLINK
MO
01
—
CD6058
RAILROAD GROUP
MO
01
—
P00143530
MEDICARE RAILROAD
MO
Enumeration date
12/15/2005
Last updated
08/10/2023
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