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NPI Code Detail

MEDICARE: DR. DIXIE DAWN KIDD D.O.

MEDICARE: DR. DIXIE DAWN KIDD D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianDO-560AL

General Provider Information

NPI Number : 1265427413
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIXIE DAWN KIDD D.O.
Provider Business Mailing Address
First Line : PO BOX 70365
Second Line :
City : MONTGOMERY
State : AL
Zip : 36107-0365
Country : US
Telephone Number : 334-420-5001
Fax Number : 334-420-0146
Provider Business Practice Location Address
First Line : 1845 CHERRY ST
Second Line :
City : MONTGOMERY
State : AL
Zip : 36107-2613
Country : US
Telephone Number : 334-420-5001
Fax Number : 334-420-0146
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2005
Last Update Date : 08/02/2013

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