Provider Demographics
NPI:1437177755
Name:KIDD, VALERIE J (MD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:J
Last Name:KIDD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 S FAIRMONT AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-5113
Mailing Address - Country:US
Mailing Address - Phone:209-339-7625
Mailing Address - Fax:209-339-7419
Practice Address - Street 1:845 S FAIRMONT AVE STE 8
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-5113
Practice Address - Country:US
Practice Address - Phone:209-339-7625
Practice Address - Fax:209-339-7419
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG056027207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G5602070Medicare ID - Type Unspecified
CAA53074Medicare UPIN