Healthcare Provider Details

I. General information

NPI: 1629179312
Provider Name (Legal Business Name): AVIAN D KIDD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 MCKINNON ST # 502
DALLAS TX
75201
US

IV. Provider business mailing address

2900 MCKINNON ST # 502
DALLAS TX
75201-1064
US

V. Phone/Fax

Practice location:
  • Phone: 972-505-1584
  • Fax: 844-582-3627
Mailing address:
  • Phone: 972-505-1584
  • Fax: 844-582-3627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberM1829
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM1829
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: