Provider Demographics
NPI:1942311378
Name:WILBUR, STANLEY M (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:M
Last Name:WILBUR
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 1:12230 LIONESS WAY
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-5603
Mailing Address - Country:US
Mailing Address - Phone:720-644-9355
Mailing Address - Fax:720-523-1654
Practice Address - Street 1:12230 LIONESS WAY
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-5603
Practice Address - Country:US
Practice Address - Phone:720-644-9355
Practice Address - Fax:720-523-1654
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72614207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G726140Medicaid
CAWG72614AMedicare ID - Type Unspecified
CA00G726140Medicaid