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General NPI Number Information
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NPI Number | 1114904257
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Entity Type | Individual
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Provider Name | MATTHEW R WILBER DPM
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Gender | Male
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 2332 CUMBERLAND SQUARE DR
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City | BETTENDORF
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State | IA
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Zip | 52722-3219
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Country | US
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Telephone | 563-391-2889
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Fax | 563-391-2988
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Provider Business Mailing Address
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Address Line | 2332 CUMBERLAND SQUARE DR
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City | BETTENDORF
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State | IA
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Zip | 52722-3219
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Country | US
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Telephone | 563-391-2889
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Fax | 563-391-2988
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 639
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License Number State | IA
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