Individual
DR. JACK G VUKOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2100 18TH AVE STE 4, ROCK ISLAND, IL 61201-3611
(309) 788-8887
Mailing address
2100 18TH AVE STE 4, ROCK ISLAND, IL 61201-3611
(309) 788-8887
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036051323
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0008100304
BLUE CROSS BLUE SHIELD
—
01
—
0335320001
ADMINA STAR
—
Enumeration date
08/24/2006
Last updated
04/23/2008
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