Provider Demographics
NPI:1780771071
Name:KIDD, R. VINCENT III (MD)
Entity type:Individual
Prefix:DR
First Name:R.
Middle Name:VINCENT
Last Name:KIDD
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:2101 ROBIN AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5772
Mailing Address - Country:US
Mailing Address - Phone:985-542-7766
Mailing Address - Fax:985-542-1754
Practice Address - Street 1:2101 ROBIN AVE
Practice Address - Street 2:STE 1
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403
Practice Address - Country:US
Practice Address - Phone:985-542-7766
Practice Address - Fax:985-542-1754
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2018-06-28
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Provider Licenses
StateLicense IDTaxonomies
LA03442R208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1145122Medicaid
LA1145122Medicaid
LA52959DD58Medicare PIN
52959B858Medicare PIN
340004389Medicare PIN
LAE41903Medicare UPIN