Individual
KYLE WAYNE HERBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4553 QUAIL LAKES DR, STOCKTON, CA 95207
(209) 951-1133
(209) 951-4708
Mailing address
4553 QUAIL LAKES DR, STOCKTON, CA 95207
(209) 951-1133
(209) 951-4708
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
A068815
CA
Other
Enumeration date
06/18/2006
Last updated
07/13/2007
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