Provider Demographics
NPI:1730167057
Name:KIDD, GRANT ADAM (DO)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:ADAM
Last Name:KIDD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:431 HIDDEN ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-7472
Mailing Address - Country:US
Mailing Address - Phone:949-885-6344
Mailing Address - Fax:
Practice Address - Street 1:2202 STATE AVE STE 201
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4582
Practice Address - Country:US
Practice Address - Phone:850-785-0029
Practice Address - Fax:850-785-7600
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS212342084N0400X
CA109242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ7XOIOtherBCBS