Basic Information
| Provider Information | |||||||||
| NPI: | 1740235191 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILBER | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4749 | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975010227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417894111 | ||||||||
| FaxNumber: | 5417895518 | ||||||||
| Practice Location | |||||||||
| Address1: | 280 MAPLE STREET | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975201552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412014000 | ||||||||
| FaxNumber: | 3303753769 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 02/20/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 35067329 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 990002104 | 01 | OH | RR MEDICARE | OTHER | 0199539 | 05 | OH | MEDICAID | 341779226W | 01 | OH | SUMMACARE | OTHER | 000000138493 | 01 | OH | ANTHEM | OTHER | 341779226003 | 01 | OH | MED MUT OF OH/ 2 OF 3 | OTHER | 61641 | 01 | OH | UNITED HEALTHCARE | OTHER | 341779226002 | 01 | OH | MED MUT OF OH/ 1 OF 3 | OTHER | 341779226006 | 01 | OH | MED MUT OF OH/ 3 OF 3 | OTHER |