Healthcare Provider Details

I. General information

NPI: 1184717845
Provider Name (Legal Business Name): ALEXANDRA E KIDD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 11/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10210 N 92ND ST SUITE 201
SCOTTSDALE AZ
85258-4509
US

IV. Provider business mailing address

10210 N 92ND ST SUITE 201
SCOTTSDALE AZ
85258-4509
US

V. Phone/Fax

Practice location:
  • Phone: 480-291-6620
  • Fax: 480-219-2213
Mailing address:
  • Phone: 480-291-6620
  • Fax: 480-219-2213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number33892
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: