Provider Demographics
NPI:1245336742
Name:WILBURN, FRANK W (MD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:W
Last Name:WILBURN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:134 COUNTY ROAD 981
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-7204
Mailing Address - Country:US
Mailing Address - Phone:662-844-3458
Mailing Address - Fax:
Practice Address - Street 1:1573 MEDICAL PARK CIR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6580
Practice Address - Country:US
Practice Address - Phone:662-844-9885
Practice Address - Fax:662-842-1350
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07268208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00111494Medicaid