MEDICARE: DR. GRANT ADAM 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
1	2084N0400X	Neurology Physician	OS21234	FL
2	2084N0400X	Neurology Physician	10924	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z7XOI	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1730167057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRANT ADAM KIDD D.O.

Provider Business Mailing Address
First Line	:	431 HIDDEN ISLAND DR
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32408-7472
Country	:	US
Telephone Number	:	949-885-6344
Fax Number	:

Provider Business Practice Location Address
First Line	:	2202 STATE AVE STE 201
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4582
Country	:	US
Telephone Number	:	850-785-0029
Fax Number	:	850-785-7600

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	03/05/2025

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