Provider Demographics
NPI:1619094687
Name:WILBUR, BRUCE JORDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:JORDAN
Last Name:WILBUR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:160 GLEN COVE MARINA RD
Mailing Address - Street 2:SUITE103
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591
Mailing Address - Country:US
Mailing Address - Phone:707-638-5700
Mailing Address - Fax:707-638-5750
Practice Address - Street 1:160 GLEN COVE MARINA RD
Practice Address - Street 2:SUITE103
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591
Practice Address - Country:US
Practice Address - Phone:707-638-5700
Practice Address - Fax:707-638-5750
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2010-10-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG77764207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine