Provider Demographics
NPI:1487142766
Name:WILBURN, MARILYN KIMBERLY (MD)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:KIMBERLY
Last Name:WILBURN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:KIMBERLY
Other - Last Name:CHAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1725 E 19TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5422
Mailing Address - Country:US
Mailing Address - Phone:918-403-7066
Mailing Address - Fax:918-744-2946
Practice Address - Street 1:3500 E FRANK PHILLIPS BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2411
Practice Address - Country:US
Practice Address - Phone:918-744-2630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK39610208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program