Healthcare Provider Details

I. General information

NPI: 1811985302
Provider Name (Legal Business Name): PERRY LEE WILBUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 GENE GEORGE BLVD
SPRINGDALE AR
72762
US

IV. Provider business mailing address

1 CHILDRENS WAY # 844
LITTLE ROCK AR
72202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 479-725-6880
  • Fax: 479-725-6582
Mailing address:
  • Phone: 501-364-2090
  • Fax: 501-364-3929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC-7167
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: