Provider Demographics
NPI:1083776199
Name:SMITH, WILBURN ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILBURN
Middle Name:ANTHONY
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2023 NORMANDIE DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111-2711
Mailing Address - Country:US
Mailing Address - Phone:334-281-6363
Mailing Address - Fax:334-284-4253
Practice Address - Street 1:2023 NORMANDIE DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2711
Practice Address - Country:US
Practice Address - Phone:334-281-6363
Practice Address - Fax:334-284-4253
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL9125207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC75507Medicare UPIN
ALG975Medicare PIN