Provider Demographics
NPI:1639121544
Name:BUKOWSKI, JACK F (MD PHD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:F
Last Name:BUKOWSKI
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BRIGHAM AND WOMEN HOSPITAL DIV OF RHEUMATOLOGY
Mailing Address - Street 2:75 FRANCIS ST
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-732-5325
Mailing Address - Fax:
Practice Address - Street 1:BRIGHAM AND WOMEN HOSPITAL DIV OF RHEUMATOLOGY
Practice Address - Street 2:75 FRANCIS ST
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-732-5325
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA73064207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology