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General NPI Number Information
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NPI Number | 1972908432
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Entity Type | Individual
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Provider Name | DARRELL WILBURN MD
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Gender | Male
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Dates
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Enumeration Date | 10/27/2014
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Last Update Date | 10/27/2014
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Provider Practice Location Address
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Address Line | 1400 E MLK JR INDUSTRIAL BLVD
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City | LOCKHART
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State | TX
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Zip | 78644-3700
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Country | US
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Telephone | 512-398-3480
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Fax | 512-268-1873
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Provider Business Mailing Address
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Address Line | 1400 E MLK JR INDUSTRIAL BLVD P.O. BOX 1170
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City | LOCKHART
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State | TX
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Zip | 78644-3700
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Country | US
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Telephone | 512-398-3480
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Fax | 512-268-1873
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | H6754
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License Number State | TX
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