Provider Demographics
NPI:1932211356
Name:KUEBLER, CHARLES W III (PA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:W
Last Name:KUEBLER
Suffix:III
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:ATTN: SHMG/HPE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-278-3821
Mailing Address - Fax:850-475-4781
Practice Address - Street 1:164 W HEWETT RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-3310
Practice Address - Country:US
Practice Address - Phone:850-278-3821
Practice Address - Fax:850-475-4781
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100651207P00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290755100Medicaid
FL290755100Medicaid
FLE3979YMedicare ID - Type Unspecified