Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 7082 | SC |
NPI | 1003868431 |
---|---|
Provider Name | Larry E Kibler |
First Address | Spartanburg, SC 29303-2248 |
Second Address | Spartanburg, SC 29303-2248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 27/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070826 | (05) | SC |
26393 | MEDCOST PIN (01) | |
4314886 | AETNA PIN (01) | |
890662F | (05) | NC |
B91799 | (02) |