Provider Demographics
NPI:1033127840
Name:KIDD, LESLIE M (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:M
Last Name:KIDD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LESLIE
Other - Middle Name:M
Other - Last Name:KIDD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2810 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6306
Mailing Address - Country:US
Mailing Address - Phone:813-877-8450
Mailing Address - Fax:813-877-6513
Practice Address - Street 1:139 S PEBBLE BEACH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-4711
Practice Address - Country:US
Practice Address - Phone:813-819-0300
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96460207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276524100Medicaid
FLP00443861OtherRAILROAD MEDICARE NUMBER
FL276524100Medicaid
FLU8287ZMedicare PIN