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General NPI Number Information
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NPI Number | 1619973864
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Entity Type | Individual
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Provider Name | JOHN P KUEBLER M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 02/03/2012
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Provider Practice Location Address
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Address Line | 810 JASONWAY AVE STE A
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City | COLUMBUS
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State | OH
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Zip | 43214-4359
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Country | US
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Telephone | 614-442-3130
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Fax | 614-442-3145
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Provider Business Mailing Address
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Address Line | 810 JASONWAY AVE STE A
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City | COLUMBUS
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State | OH
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Zip | 43214-4359
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Country | US
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Telephone | 614-442-3130
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Fax | 614-442-3145
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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 | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 35044102
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License Number State | OH
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