Provider Demographics
NPI:1053494674
Name:KIDD, RODNEY DESMOND JR (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:DESMOND
Last Name:KIDD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7418 JOHN SMITH
Mailing Address - Street 2:SUITE 218
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6020
Mailing Address - Country:US
Mailing Address - Phone:210-614-0959
Mailing Address - Fax:210-614-7522
Practice Address - Street 1:7418 JOHN SMITH
Practice Address - Street 2:SUITE 218
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6020
Practice Address - Country:US
Practice Address - Phone:210-614-0959
Practice Address - Fax:210-614-7522
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL74522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185135405Medicaid
TXP00866534OtherMEDICARE RAILROAD
TXTXB107209Medicare PIN
TXP00866534OtherMEDICARE RAILROAD