MEDICARE: JOHN ROBERT KIDD MD

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
1	207L00000X	Anesthesiology Physician	MD24096	ME
2	207L00000X	Anesthesiology Physician	8161	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598762098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ROBERT KIDD MD

Provider Business Mailing Address
First Line	:	324 GANNETT DR
Second Line	:	STE 200
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-3266
Country	:	US
Telephone Number	:	207-482-7800
Fax Number	:	207-482-7898

Provider Business Practice Location Address
First Line	:	2320 PASEO DEL PRADO
Second Line	:	# B-207
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4358
Country	:	US
Telephone Number	:	702-873-4567
Fax Number	:	702-873-0414

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	04/20/2021

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Directions to “ JOHN ROBERT KIDD MD” Practice Location

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