Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | L6467 | TX |
NPI | 1184697674 |
---|---|
Provider Name | Dr. Joseph N Kidd JR. |
First Address | Richardson, TX 75082-3542 |
Second Address | San Antonio, TX 78229-3735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 10/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
159269301 | (05) | TX |
H89474 | (02) | TX |