Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | LT000789 | PA |
NPI | 1710406103 |
---|---|
Provider Name | Dr. Eliezer Sidon |
First Address | Wynnewood, PA 19096-2624 |
Second Address | Philadelphia, PA 19107-4308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2017 |
Last Update Date | 17/09/2017 |