Provider Demographics
NPI:1619973864
Name:KUEBLER, JOHN P (MD, PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:KUEBLER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 JASONWAY AVE
Mailing Address - Street 2:STE A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-4359
Mailing Address - Country:US
Mailing Address - Phone:614-442-3130
Mailing Address - Fax:614-442-3145
Practice Address - Street 1:810 JASONWAY AVE
Practice Address - Street 2:STE A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-4359
Practice Address - Country:US
Practice Address - Phone:614-442-3130
Practice Address - Fax:614-442-3145
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044102207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11548OtherNATIONWIDE
OH830002061OtherRAILROAD MEDICARE
OH3600069OtherUHC
OH00000013858OtherANTHEM
OH0802868Medicaid
OH3600069OtherUHC
OH11548OtherNATIONWIDE