Provider Demographics
NPI:1346423449
Name:WILBERFORCE, SIDNEY HORATIO (MD)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:HORATIO
Last Name:WILBERFORCE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1425 S MAIN ST
Mailing Address - Street 2:1ST FLOOR - UROLOGY
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1425 S MAIN ST
Practice Address - Street 2:1ST FLOOR - UROLOGY
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5318
Practice Address - Country:US
Practice Address - Phone:925-295-4060
Practice Address - Fax:925-295-5544
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2022-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA117191208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology