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1528621067 NPI number — CLAYTON EUGENE KIBLER MD, MMS

NPI Number: 1528621067
Health Care Provider/Practitioner: CLAYTON EUGENE KIBLER MD, MMS

Information about “1528621067” NPI (CLAYTON EUGENE KIBLER MD, MMS) exists in 1528621067 in HTML format HTML  |  1528621067 in plain Text format TXT  |  1528621067 in PDF (Portable Document Format) PDF  |  1528621067 in an XML format XML  formats.

NPI Number : 1528621067 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1528621067",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KIBLER",
    "FirstName": "CLAYTON",
    "MiddleName": "EUGENE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD, MMS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1183 SABLE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RANCHO SANTA MARGARITA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92688-5589",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "281-755-6203",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "33608 ORTEGA HWY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAN JUAN CAPISTRANO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92675-2042",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "800-642-4657",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/19/2019",
    "LastUpdateDate": "07/14/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207ZP0102X",
        "TaxonomyName": "Anatomic Pathology & Clinical Pathology Physician",
        "LicenseNumber": "MD2023-0481",
        "LicenseNumberStateCode": "NM",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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