Provider Demographics
NPI:1205029386
Name:WILBUR, BEVERLY A (DO)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:WILBUR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:A
Other - Last Name:WILBUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:200 MLK JR BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-1152
Mailing Address - Country:US
Mailing Address - Phone:940-766-6306
Mailing Address - Fax:
Practice Address - Street 1:1301 3RD ST STE 200
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-2245
Practice Address - Country:US
Practice Address - Phone:214-372-8164
Practice Address - Fax:214-372-8149
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202303207Q00000X
GA001953207Q00000X
TXQ7102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine