Provider Demographics
NPI:1265727713
Name:KUEBLER, RICARD
Entity type:Individual
Prefix:
First Name:RICARD
Middle Name:
Last Name:KUEBLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 VINTON AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5027
Mailing Address - Country:US
Mailing Address - Phone:901-301-7240
Mailing Address - Fax:
Practice Address - Street 1:1640 VINTON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-5027
Practice Address - Country:US
Practice Address - Phone:901-301-7240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor