Provider Demographics
NPI:1528397023
Name:ROBERT B. KIDD MD APMC
Entity Type:Organization
Organization Name:ROBERT B. KIDD MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-542-1226
Mailing Address - Street 1:15770 PAUL VEGA MD DR
Mailing Address - Street 2:200
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1475
Mailing Address - Country:US
Mailing Address - Phone:985-542-1226
Mailing Address - Fax:985-542-2887
Practice Address - Street 1:15770 PAUL VEGA MD DR
Practice Address - Street 2:200
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1475
Practice Address - Country:US
Practice Address - Phone:985-542-1226
Practice Address - Fax:985-542-2887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15801208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1343510Medicaid
LA1343510Medicaid
LA5L374Medicare PIN