Healthcare Provider Details

I. General information

NPI: 1477786515
Provider Name (Legal Business Name): ALEX HEATON GUBLER AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 MDG UNIT 3690
APO AE
09126-3690
US

IV. Provider business mailing address

PSC 78 BOX 3136
APO AP
96326-0032
US

V. Phone/Fax

Practice location:
  • Phone: 314-452-8238
  • Fax:
Mailing address:
  • Phone: 813-325-9822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number81190994101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: