Provider Demographics
NPI:1245252063
Name:KIDD, OSCAR (MD)
Entity type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:
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:PO BOX 2017 PMB 586
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771
Mailing Address - Country:US
Mailing Address - Phone:787-716-0740
Mailing Address - Fax:787-716-0904
Practice Address - Street 1:CARR#198 KM 23.6
Practice Address - Street 2:BO COLLORES
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:787-716-0740
Practice Address - Fax:787-716-0904
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9401207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0081547Medicare PIN
PRE66624Medicare UPIN