Provider Demographics
NPI:1932191350
Name:SANFORD, WILBUR CLARENCE (MD)
Entity Type:Individual
Prefix:MR
First Name:WILBUR
Middle Name:CLARENCE
Last Name:SANFORD
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 1:16085 TUSCOLA RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1358
Mailing Address - Country:US
Mailing Address - Phone:760-242-3449
Mailing Address - Fax:760-242-1498
Practice Address - Street 1:16085 TUSCOLA RD
Practice Address - Street 2:SUITE 2
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1358
Practice Address - Country:US
Practice Address - Phone:760-242-3449
Practice Address - Fax:760-242-1498
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA030525207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
8772887600OtherRAILROAD MEDICARE
00A305250Medicare ID - Type Unspecified
A26136Medicare UPIN