Provider Demographics
NPI:1316728397
Name:ROBERT A KIDDY III
Entity type:Organization
Organization Name:ROBERT A KIDDY III
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALFRED
Authorized Official - Last Name:KIDDY
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:509-528-3668
Mailing Address - Street 1:3500 W. COURT ST.
Mailing Address - Street 2:P.O. BOX 4920
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-4920
Mailing Address - Country:US
Mailing Address - Phone:509-528-3668
Mailing Address - Fax:
Practice Address - Street 1:8479 W CLEARWATER AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8628
Practice Address - Country:US
Practice Address - Phone:509-581-2830
Practice Address - Fax:509-581-2830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-06
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty