Healthcare Provider Details

I. General information

NPI: 1366448839
Provider Name (Legal Business Name): GERARD J KERBLESKI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 03/26/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 CARMEL AVE NE STE 501
ALBUQUERQUE NM
87122-3125
US

IV. Provider business mailing address

8300 CARMEL AVE NE STE 501
ALBUQUERQUE NM
87122-3125
US

V. Phone/Fax

Practice location:
  • Phone: 505-717-1274
  • Fax: 505-717-1879
Mailing address:
  • Phone: 505-717-1274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number209
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: