Healthcare Provider Details

I. General information

NPI: 1275574527
Provider Name (Legal Business Name): CHRISTOPHER T. KUEBRICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 MEDICAL CENTER DR E STE 106
CLOVIS CA
93611-6811
US

IV. Provider business mailing address

670 MASON RIDGE CENTER DR STE. 300
SAINT LOUIS MO
63141-8573
US

V. Phone/Fax

Practice location:
  • Phone: 559-387-2090
  • Fax: 559-387-2099
Mailing address:
  • Phone: 314-996-7644
  • Fax: 314-996-7658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC54664
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036116096
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: