Provider Demographics
NPI:1942395413
Name:KIDD, CLOID REILEY (MD)
Entity Type:Individual
Prefix:DR
First Name:CLOID
Middle Name:REILEY
Last Name:KIDD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1660 S COLUMBIAN WAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1532
Mailing Address - Country:US
Mailing Address - Phone:206-277-1852
Mailing Address - Fax:206-277-3415
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-277-1852
Practice Address - Fax:206-277-3415
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD000147712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAB18156Medicare UPIN