Provider Demographics
NPI:1740235191
Name:WILBER, SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:WILBER
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:PO BOX 4749
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0227
Mailing Address - Country:US
Mailing Address - Phone:541-789-4111
Mailing Address - Fax:541-789-5518
Practice Address - Street 1:280 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97520-1552
Practice Address - Country:US
Practice Address - Phone:541-201-4000
Practice Address - Fax:330-375-3769
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067329207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH990002104OtherRR MEDICARE
OH0199539Medicaid
OH341779226WOtherSUMMACARE
OH000000138493OtherANTHEM
OH341779226003OtherMED MUT OF OH/ 2 OF 3
OH61641OtherUNITED HEALTHCARE
OH341779226002OtherMED MUT OF OH/ 1 OF 3
OH341779226006OtherMED MUT OF OH/ 3 OF 3
OH000000138493OtherANTHEM
OH61641OtherUNITED HEALTHCARE
OH0795186Medicare ID - Type Unspecified3 OF 3
OH0795183Medicare ID - Type Unspecified2 OF 3