Provider Demographics
NPI:1629179312
Name:KIDD, AVIAN D (MD)
Entity Type:Individual
Prefix:
First Name:AVIAN
Middle Name:D
Last Name:KIDD
Suffix:
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 1:2900 MCKINNON ST # 502
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-1064
Mailing Address - Country:US
Mailing Address - Phone:972-505-1584
Mailing Address - Fax:844-582-3627
Practice Address - Street 1:2900 MCKINNON ST # 502
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201
Practice Address - Country:US
Practice Address - Phone:972-505-1584
Practice Address - Fax:844-582-3627
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1829208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175473105Medicaid
TX8X0055OtherBCBS
TX175473101Medicaid
TX175473104Medicaid
TX8S3699OtherBCBS
TX175473103Medicaid
TX8BR081OtherBCBS
TXP00709059Medicare PIN
TX8D6962Medicare PIN
TX8J7525Medicare PIN
TX8S3699OtherBCBS
TXP00404434Medicare PIN
TX175473103Medicaid
TX8J7526Medicare PIN