Provider Demographics
NPI:1609978899
Name:JUGO, SLOBODAN B (PSC)
Entity Type:Individual
Prefix:DR
First Name:SLOBODAN
Middle Name:B
Last Name:JUGO
Suffix:
Gender:M
Credentials:PSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MEDICAL PLAZA
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345
Mailing Address - Country:US
Mailing Address - Phone:270-338-6650
Mailing Address - Fax:270-338-6653
Practice Address - Street 1:300 MEDICAL PLAZA
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345
Practice Address - Country:US
Practice Address - Phone:270-338-6650
Practice Address - Fax:270-338-6653
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21212207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64212129Medicaid
KY0963301Medicare ID - Type Unspecified
KY64212129Medicaid