MEDICARE: DARIN KEITH WILBOURN MD

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	208100000X	Physical Medicine & Rehabilitation Physician	C8478	AR

General Provider Information

NPI Number	:	1770561532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARIN KEITH WILBOURN MD

Provider Business Mailing Address
First Line	:	410 W PERSHING BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-2146
Country	:	US
Telephone Number	:	501-771-0674
Fax Number	:	501-753-4174

Provider Business Practice Location Address
First Line	:	410 W PERSHING BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-2146
Country	:	US
Telephone Number	:	501-771-0674
Fax Number	:	501-753-4174

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	06/11/2014

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