Healthcare Provider Details

I. General information

NPI: 1467425348
Provider Name (Legal Business Name): JOSEPH F KIBLER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 DOCTORS CIR SUITE 2
SUPPLY NC
28462-4088
US

IV. Provider business mailing address

14 DOCTORS CIR SUITE 2
SUPPLY NC
28462-4088
US

V. Phone/Fax

Practice location:
  • Phone: 910-755-6512
  • Fax: 910-755-6548
Mailing address:
  • Phone: 910-755-6512
  • Fax: 910-755-6548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number452
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number452
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number452
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: