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1053494674 NPI number — RODNEY DESMOND KIDD JR. M.D.

NPI Number: 1053494674
Health Care Provider/Practitioner: RODNEY DESMOND KIDD JR. M.D.

Information about “1053494674” NPI (RODNEY DESMOND KIDD JR. M.D.) exists in 1053494674 in HTML format HTML  |  1053494674 in plain Text format TXT  |  1053494674 in PDF (Portable Document Format) PDF  |  1053494674 in an XML format XML  formats.

NPI Number : 1053494674 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053494674",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KIDD",
    "FirstName": "RODNEY",
    "MiddleName": "DESMOND",
    "NamePrefix": null,
    "NameSuffix": "JR.",
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7375 W 52ND AVE STE 210",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ARVADA",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "80002-3748",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "303-223-4448",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "7418 JOHN SMITH",
    "SecondLinePracticeLocationAddress": "SUITE 218",
    "PracticeLocationAddressCityName": "SAN ANTONIO",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78229-6020",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "210-614-0959",
    "PracticeLocationAddressFaxNumber": "210-614-7522",
    "EnumerationDate": "10/24/2006",
    "LastUpdateDate": "10/29/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2085R0202X",
          "TaxonomyName": "Diagnostic Radiology Physician",
          "LicenseNumber": "CDR.0005235",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2085R0202X",
          "TaxonomyName": "Diagnostic Radiology Physician",
          "LicenseNumber": "L7452",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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