Provider Demographics
NPI:1467425348
Name:KIBLER, JOSEPH F (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:F
Last Name:KIBLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 DOCTORS CIR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-4088
Mailing Address - Country:US
Mailing Address - Phone:910-755-6512
Mailing Address - Fax:910-755-6548
Practice Address - Street 1:14 DOCTORS CIR
Practice Address - Street 2:SUITE 2
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4088
Practice Address - Country:US
Practice Address - Phone:910-755-6512
Practice Address - Fax:910-755-6548
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC452213EP1101X, 213ES0131X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5199990001OtherMEDICARE DMERC PTAN
NC890806XMedicaid
NC2433637AMedicare ID - Type UnspecifiedINDIVIDUAL
NC2339324Medicare ID - Type UnspecifiedGROUP
NC890806XMedicaid
NC1396874285Medicare NSC