Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 15801 | LA |
NPI | 1053378166 |
---|---|
Provider Name | Dr. Robert B Kidd |
First Address | Hammond, LA 70403-1475 |
Second Address | Hammond, LA 70403-1475 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 10/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1343510 | (05) | LA |
B61290 | (02) | LA |