Provider Demographics
NPI:1114904257
Name:WILBER, MATTHEW R (DPM)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:R
Last Name:WILBER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2332 CUMBERLAND SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3219
Mailing Address - Country:US
Mailing Address - Phone:563-391-2889
Mailing Address - Fax:563-391-2988
Practice Address - Street 1:2332 CUMBERLAND SQUARE DR
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3219
Practice Address - Country:US
Practice Address - Phone:563-391-2889
Practice Address - Fax:563-391-2988
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA639213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAU62524Medicare UPIN