MEDICARE: JIMMIE J. WILBUR M.D.

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
1	207R00000X	Internal Medicine Physician	ME0067395	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27003	OTHER	FL	BCBS
2	0623182	OTHER	FL	AETNA

General Provider Information

NPI Number	:	1194743575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMIE J. WILBUR M.D.

Provider Business Mailing Address
First Line	:	4450 E FLETCHER AVE
Second Line	:	SUITE C
City	:	TAMPA
State	:	FL
Zip	:	33613-4907
Country	:	US
Telephone Number	:	813-971-3136
Fax Number	:	813-910-3569

Provider Business Practice Location Address
First Line	:	4450 E FLETCHER AVE
Second Line	:	SUITE C
City	:	TAMPA
State	:	FL
Zip	:	33613-4907
Country	:	US
Telephone Number	:	813-971-3136
Fax Number	:	813-910-3569

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	03/22/2016

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