Provider Demographics
NPI:1598762098
Name:KIDD, JOHN ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:KIDD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:324 GANNETT DR
Mailing Address - Street 2:STE 200
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3266
Mailing Address - Country:US
Mailing Address - Phone:207-482-7800
Mailing Address - Fax:207-482-7898
Practice Address - Street 1:2320 PASEO DEL PRADO
Practice Address - Street 2:# B-207
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4358
Practice Address - Country:US
Practice Address - Phone:702-873-4567
Practice Address - Fax:702-873-0414
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2021-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEMD24096207L00000X
NV8161207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019867Medicaid