MEDICARE: NILA L 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	174400000X	Specialist	9401092	NC

Other Identifiers

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

General Provider Information

NPI Number	:	1528065802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NILA L WILBUR M.D.

Provider Business Mailing Address
First Line	:	934 UPPER CRABTREE RD
Second Line	:
City	:	CLYDE
State	:	NC
Zip	:	28721-7719
Country	:	US
Telephone Number	:
Fax Number	:	828-452-8338

Provider Business Practice Location Address
First Line	:	262 LEROY GEORGE DR
Second Line	:	STE X
City	:	CLYDE
State	:	NC
Zip	:	28721-7430
Country	:	US
Telephone Number	:	828-452-8346
Fax Number	:

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	03/07/2023

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