Provider Demographics
NPI:1497717276
Name:KIDD, JEFFREY ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
Last Name:KIDD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 TREEMONT DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7953
Mailing Address - Country:US
Mailing Address - Phone:386-951-6684
Mailing Address - Fax:386-960-8948
Practice Address - Street 1:152 TREEMONTE DR
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7953
Practice Address - Country:US
Practice Address - Phone:386-951-6684
Practice Address - Fax:386-960-8948
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68980207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51540OtherBC/BS
51540BMedicare ID - Type Unspecified