Provider Demographics
NPI:1962519314
Name:WILBURN, ROBERT L (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:WILBURN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 9TH AVE
Mailing Address - Street 2:MS M4-PA
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-583-6025
Mailing Address - Fax:206-515-5886
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00012116207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAUS0818851OtherAETNA/USHC PCP
WAW568OtherBLUE SHIELD
WAMD211WAOtherALASKA MEDICAID
WA0039589OtherLABOR & INDUSTRY
WA8269409Medicaid
WAUS0899920OtherAETNA/USHC SPECIALIST
390003068OtherRAILROAD MEDICARE
WA000182105Medicare PIN
E20075Medicare UPIN
WAUS0899920OtherAETNA/USHC SPECIALIST
WAUS0818851OtherAETNA/USHC PCP