Provider Demographics
NPI:1194743575
Name:WILBUR, JIMMIE J (MD)
Entity type:Individual
Prefix:
First Name:JIMMIE
Middle Name:J
Last Name:WILBUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 E FLETCHER AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4907
Mailing Address - Country:US
Mailing Address - Phone:813-971-3136
Mailing Address - Fax:813-910-3569
Practice Address - Street 1:4450 E FLETCHER AVE
Practice Address - Street 2:SUITE C
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4907
Practice Address - Country:US
Practice Address - Phone:813-971-3136
Practice Address - Fax:813-910-3569
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067395207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27003OtherBCBS
FL0623182OtherAETNA
FL27003OtherBCBS
FL27003OtherBCBS