Healthcare Provider Details

I. General information

NPI: 1831204031
Provider Name (Legal Business Name): ELISE L KIBLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 LOCKE ST
SAN ANTONIO TX
78208-2127
US

IV. Provider business mailing address

903 W MARTIN ST # MS 49-2
SAN ANTONIO TX
78207-0903
US

V. Phone/Fax

Practice location:
  • Phone: 210-644-8700
  • Fax: 210-702-4326
Mailing address:
  • Phone: 201-358-5909
  • Fax: 210-358-5940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM1184
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: