Provider Demographics
NPI:1386954360
Name:WILBUR C SANFORD MD INC
Entity type:Organization
Organization Name:WILBUR C SANFORD MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILBUR
Authorized Official - Middle Name:C
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-242-3449
Mailing Address - Street 1:16085 TUSCOLA RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1358
Mailing Address - Country:US
Mailing Address - Phone:760-242-3449
Mailing Address - Fax:760-242-1498
Practice Address - Street 1:16085 TUSCOLA RD
Practice Address - Street 2:SUITE 2
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1358
Practice Address - Country:US
Practice Address - Phone:760-242-3449
Practice Address - Fax:760-242-1498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30525207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty