Individual
PERRY LEE WILBUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2601 GENE GEORGE BLVD, SPRINGDALE, AR 72762
(479) 725-6880
(479) 725-6582
Mailing address
1 CHILDRENS WAY # 844, LITTLE ROCK, AR 72202-3500
(501) 364-2090
(501) 364-3929
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
C-7167
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115794001
—
AR
05
—
122523002
—
AR
01
—
157490000
QUALCHOICE
AR
01
—
53356
AR BLUE CROSS BLUE SHIELD
AR
Enumeration date
10/10/2005
Last updated
06/21/2018
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