Provider Demographics
NPI:1528621067
Name:KIBLER, CLAYTON EUGENE (MD, MMS)
Entity type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:EUGENE
Last Name:KIBLER
Suffix:
Gender:M
Credentials:MD, MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183 SABLE
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-5589
Mailing Address - Country:US
Mailing Address - Phone:281-755-6203
Mailing Address - Fax:
Practice Address - Street 1:33608 ORTEGA HWY
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2042
Practice Address - Country:US
Practice Address - Phone:800-642-4657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2023-0481207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty