Healthcare Provider Details

I. General information

NPI: 1679587612
Provider Name (Legal Business Name): RANDY LEE GUBLER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 NORTH BUFFALO DRIVE SUITE 107
LAS VEGAS NV
89129-7410
US

IV. Provider business mailing address

3320 NORTH BUFFALO DRIVE SUITE 107
LAS VEGAS NV
89129-7410
US

V. Phone/Fax

Practice location:
  • Phone: 702-256-8454
  • Fax: 702-256-0387
Mailing address:
  • Phone: 702-256-8454
  • Fax: 702-256-0387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number9804
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: