Kenneth Widder, M.D.

Primary specialty

Anatomic Pathology PhysicianTaxonomy code 207ZP0101X

License

G46485 Issued in CA

Practice address

16231 El Camino Real
Rancho Santa Fe, CA 92067

Phone

(619) 507-9827

NPI assigned

Mar 10, 2015

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1425945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425945600000",
    "number": "1861885295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 676250",
            "city": "RANCHO SANTA FE",
            "state": "CA",
            "postal_code": "920676250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16231 EL CAMINO REAL",
            "city": "RANCHO SANTA FE",
            "state": "CA",
            "postal_code": "92067",
            "telephone_number": "619-507-9827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDDER",
        "first_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-03-10",
        "last_updated": "2015-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "CA",
            "license": "G46485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Wagner, MS
• Joseph Benjamin Weiss, M.D.
• Lisa Michelle Weiss, O.D.
• Herbert Nathaniel Weissman, PH.D.
• Christine Anna White, M.D.
• Jennifer Winter, DNP, AGNP
• Katherine Jennifer Witmeyer, O.D.
• David K. Woodruff, AU.D
• Wyn Enterprises
• Aliza Zisman, LIC. AC.

• Anatomic Pathology Physician in Rancho Santa Fe, CA
• Providers in Rancho Santa Fe, CA by specialty
• Anatomic Pathology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.