Individual
DR. KENNETH WIDDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
16231 EL CAMINO REAL, RANCHO SANTA FE, CA 92067
(619) 507-9827
Mailing address
PO BOX 676250, RANCHO SANTA FE, CA 92067-6250
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
G46485
CA
Other
Enumeration date
03/10/2015
Last updated
03/10/2015
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