Provider Demographics
NPI:1417138322
Name:KIDD, MATTHEW CHARLES (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CHARLES
Last Name:KIDD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-8800
Mailing Address - Fax:303-415-8801
Practice Address - Street 1:4801 RIVERBEND RD STE 200
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2613
Practice Address - Country:US
Practice Address - Phone:303-415-8800
Practice Address - Fax:303-415-8801
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR00533892084N0400X
TXP53962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68377258Medicaid
CO68377258Medicaid