Provider Demographics
NPI:1063827715
Name:GUBLER, JASON TYLER (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:TYLER
Last Name:GUBLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10624 S EASTERN AVE STE A-955
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2982
Mailing Address - Country:US
Mailing Address - Phone:702-407-7700
Mailing Address - Fax:702-407-7016
Practice Address - Street 1:10624 S EASTERN AVE STE A-955
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2982
Practice Address - Country:US
Practice Address - Phone:702-407-7700
Practice Address - Fax:702-407-7016
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13419207Q00000X
NVDO1975207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine