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General NPI Number Information
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NPI Number | 1538376496
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Entity Type | Individual
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Provider Name | BRANDON EDWARD KUEBLER MD
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/08/2024
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Provider Practice Location Address
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Address Line | 841 PRUDENTIAL DR STE 280
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8350
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Country | US
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Telephone | 904-202-8550
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Fax | 904-393-7808
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Provider Business Mailing Address
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Address Line | PO BOX 746645
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City | ATLANTA
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State | GA
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Zip | 30374-6645
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Country | US
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Telephone | 904-202-2092
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Fax | 904-376-4075
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101243850
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 65697
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | ME109642
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License Number State | FL
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