MEDICARE: DR. WILBUR DUBOIS VANBUREN II M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	104286	MO

General Provider Information

NPI Number	:	1720086853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILBUR DUBOIS VANBUREN II M.D.

Provider Business Mailing Address
First Line	:	308 W 8TH ST
Second Line	:	208
City	:	KANSAS CITY
State	:	MO
Zip	:	64105-1579
Country	:	US
Telephone Number	:	816-229-2557
Fax Number	:	816-221-4946

Provider Business Practice Location Address
First Line	:	308 W 8TH ST
Second Line	:	208
City	:	KANSAS CITY
State	:	MO
Zip	:	64105-1579
Country	:	US
Telephone Number	:	816-229-2557
Fax Number	:	816-221-4946

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/09/2007

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