Individual
STANLEY SIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
211 SAINT FRANCIS DR, SUITE 372, CAPE GIRARDEAU, MO 63703-5049
(573) 331-5525
(573) 331-5534
Mailing address
PO BOX 843225, KANSAS CITY, MO 64184-3225
(813) 262-8160
(813) 891-6528
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
R5439
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
133641
HEALTHLINK
—
05
—
200248714
—
MO
01
—
204849
BCBS
MO
01
—
P00303937
RAILROAD MEDICARE
—
Enumeration date
05/13/2006
Last updated
04/10/2013
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