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NPI Code Detail

MEDICARE: LLOYD GLENWOOD WILBERT III MD

MEDICARE: LLOYD GLENWOOD WILBERT III 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
12085R0202XDiagnostic Radiology PhysicianK1320TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053310359
Entity Type Code : Individual
Provider Name (Legal Business Name) : LLOYD GLENWOOD WILBERT III MD
Provider Business Mailing Address
First Line : 1845 PRECINCT LINE RD STE 209
Second Line :
City : HURST
State : TX
Zip : 76054-3109
Country : US
Telephone Number : 817-336-4638
Fax Number : 817-336-1331
Provider Business Practice Location Address
First Line : 1845 PRECINCT LINE RD STE 209
Second Line :
City : HURST
State : TX
Zip : 76054-3109
Country : US
Telephone Number : 817-336-4638
Fax Number : 817-336-1331
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 07/13/2021

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