Provider Demographics
NPI:1184657637
Name:KIBLER, GEORGE KENT (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:KENT
Last Name:KIBLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1009
Mailing Address - Street 2:
Mailing Address - City:LONE PINE
Mailing Address - State:CA
Mailing Address - Zip Code:93545-1009
Mailing Address - Country:US
Mailing Address - Phone:760-876-5501
Mailing Address - Fax:760-876-4388
Practice Address - Street 1:501 E. LOCUST STREET
Practice Address - Street 2:
Practice Address - City:LONE PINE
Practice Address - State:CA
Practice Address - Zip Code:93545-1009
Practice Address - Country:US
Practice Address - Phone:760-876-5501
Practice Address - Fax:760-876-4388
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC37172207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C371720OtherBLUE CROSS
CA00C371720OtherBLUE SHIELD
CA183283900OtherWORKERS COMP
CA770051426001OtherTRICARE
WA0205422OtherWA WORKERS COMP
CARHM53941FMedicaid
CAC37172OtherLICENSE
CAGR0021672Medicaid
NV002086560Medicaid
CAGR0021672Medicaid
CA183283900OtherWORKERS COMP
CA553941Medicare ID - Type Unspecified
WA0205422OtherWA WORKERS COMP
CAA36518Medicare UPIN