Clovis Dermatology, Inc

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

CLOVIS DERMATOLOGY, INC

Doing business as

Clovis Dermatology

Practice address

275 W Herndon Ave
Clovis, CA 93612-0204

Phone

(559) 321-4255

NPI assigned

Feb 14, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Raymond Kidwell, M.D.NPI 1801978457

Title

Ceo

Phone

(559) 298-7220

Specialties & licenses 1

Addresses

Other names 1

• Clovis Dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Raymond Earl Kidwell, MD

  • Dermatology Physician
  • Clovis, CA
  • NPI 1801978457
  Medicare reassignment Care Compare group NPD Authorized official
• Jacqueline Polach, PA

  • Physician Assistant
  • Fresno, CA
  • NPI 1760733208
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1455408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616457600000",
    "number": "1952760308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 W HERNDON AVE",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936120204",
            "telephone_number": "559-321-4255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 W HERNDON AVE",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936120204",
            "telephone_number": "559-321-4255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLOVIS DERMATOLOGY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-14",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A",
        "authorized_official_last_name": "KIDWELL",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "559-298-7220",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clovis Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clovis Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marty Clayman, M.D.
• Ron J Climer, L.C.S.W.
• Annita Mae Cline, FNP
• Clovis Adult Day Health Care, Inc
• Clovis Community Medical Center
• Clovis Endoscopy ASC, LLC
• Clovis Family Therapy, Inc.
• Clovis Gentle Dental Care
• Clovis Global Academy
• Clovis Hybrid Autism Program (Chaps)

• Dermatology Physician in Clovis, CA
• Providers in Clovis, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.