Healthcare Provider Details

I. General information

NPI: 1912358912
Provider Name (Legal Business Name): KARL GUBLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52D MEDICAL GROUP UNIT 3690
APO AE
09126
US

IV. Provider business mailing address

7321 BALMER STREET BUILDING 570 75TH MEDICAL GROUP
HILL AFB UT
84056
US

V. Phone/Fax

Practice location:
  • Phone: 314-452-8153
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30549
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: