1851462998 NPI number — JACQUELINE VUKY M.D.

Table of content: JACQUELINE VUKY M.D. (NPI 1851462998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851462998 NPI number — JACQUELINE VUKY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VUKY
Provider First Name:
JACQUELINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851462998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1130 NW 22ND AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97210-2934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-299-6500
Provider Business Mailing Address Fax Number:
503-299-6422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1130 NW 22ND AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97210-2934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-299-6500
Provider Business Practice Location Address Fax Number:
503-299-6422
Provider Enumeration Date:
11/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  MD00039647 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: MD154135 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: US2552763 . This is a "AETNA SPECIALIST PIN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 110225174 . This is a "RAILROAD MC#" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0039582 . This is a "LABOR AND INDUSTRIES #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: MD0867W , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2341VU . This is a "BLUE SHIELD #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8284580 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 806245600 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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