Individual
RAYMOND EARL KIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
275 HERNDON AVENUE, SUITE 131, CLOVIS, CA 93612
(559) 298-7220
(559) 298-7060
Mailing address
275 W HERNDON AVE, CLOVIS, CA 93612-0204
(559) 298-7220
(909) 557-1924
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
A66131
CA
207Q00000X
Family Medicine Physician
A66131
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00439927
RAILROAD MEDICARE
CA
01
—
P00767385
RAILROAD MEDICARE
CA
Enumeration date
10/20/2006
Last updated
03/23/2021
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