Individual
WALTER M KIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7435 W AZURE DR STE 190, LAS VEGAS, NV 89130-4427
(702) 788-5252
(702) 878-9096
Mailing address
4045 S BUFFALO DR, A101-172, LAS VEGAS, NV 89147-7479
(702) 878-8252
(702) 878-9096
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
9263
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100791
GROUP
NV
01
—
33452
MEDICARE ORIGINAL
NV
Enumeration date
06/08/2006
Last updated
06/12/2019
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