Individual
JACK W LENOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1235 N MULFORD RD, STE 200, ROCKFORD, IL 61107-3879
(815) 965-6644
(815) 965-2901
Mailing address
1235 N MULFORD RD, STE 200, ROCKFORD, IL 61107-3879
(815) 965-6644
(815) 965-2901
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
03608164
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03608164
—
IL
01
—
10100643
BLUECROSS
—
Enumeration date
08/16/2006
Last updated
12/27/2020
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