Healthcare Provider Details

I. General information

NPI: 1912037151
Provider Name (Legal Business Name): BRUCE G WILBUR MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 SAMARITAN DR
SAN JOSE CA
95124-3912
US

IV. Provider business mailing address

2450 SAMARITAN DR
SAN JOSE CA
95124-3912
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-1855
  • Fax: 408-356-4183
Mailing address:
  • Phone: 408-358-1855
  • Fax: 408-356-4183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG18447
License Number StateCA

VIII. Authorized Official

Name: DR. BRUCE GEORGE WILBUR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 408-358-1855