Organization
BRUNSWICK FOOT & ANKLE SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH KIBLER DPM (OWNER)
(919) 751-9120
Entity
Organization
Contact information
Practice address
14 DOCTORS CIR, SUITE 2, SUPPLY, NC 28462-4097
(919) 751-9120
(919) 751-9170
Mailing address
14 DOCTORS CIR, SUITE 2, SUPPLY, NC 28462-4097
(919) 751-9120
(919) 751-9170
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
452
NC
261QP1100X
Podiatric Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5199990001
MEDICARE DMERC PTAN
NC
05
—
890806X
—
NC
Enumeration date
03/05/2007
Last updated
09/21/2011
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