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General NPI Number Information
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NPI Number | 1225655749
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Entity Type | Individual
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Provider Name | VICTOR KIEBALO MD
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Gender | Male
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Dates
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Enumeration Date | 06/30/2020
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 4500 SAN PABLO RD S
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City | JACKSONVILLE
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State | FL
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Zip | 32224-1865
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Country | US
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Telephone | 904-953-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 940 NE 13TH ST. GARRISON TOWER, SUITE 3G 3210
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-5008
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Country | US
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Telephone | 405-271-8001
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 38205
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME173325
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License Number State | FL
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