Healthcare Provider Details

I. General information

NPI: 1184657637
Provider Name (Legal Business Name): GEORGE KENT KIBLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E. LOCUST STREET
LONE PINE CA
93545-1009
US

IV. Provider business mailing address

P.O. BOX 1009
LONE PINE CA
93545-1009
US

V. Phone/Fax

Practice location:
  • Phone: 760-876-5501
  • Fax: 760-876-4388
Mailing address:
  • Phone: 760-876-5501
  • Fax: 760-876-4388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC37172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: