MEDICARE: DR. RANDY LEE GUBLER D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	9804	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	480029166	OTHER	NV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1943324	OTHER	NV	UNITED HEALTH CARE
2	CC1573	OTHER	NV	BLUE CROSS/BLUE SHIELD
4	7208106	OTHER	NV	AETNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679587612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDY LEE GUBLER D.P.M.

Provider Business Mailing Address
First Line	:	3320 NORTH BUFFALO DRIVE
Second Line	:	SUITE 107
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7410
Country	:	US
Telephone Number	:	702-256-8454
Fax Number	:	702-256-0387

Provider Business Practice Location Address
First Line	:	3320 NORTH BUFFALO DRIVE
Second Line	:	SUITE 107
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7410
Country	:	US
Telephone Number	:	702-256-8454
Fax Number	:	702-256-0387

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	12/03/2014

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Directions to “ DR. RANDY LEE GUBLER D.P.M.” Practice Location

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