Provider Demographics
NPI:1710063573
Name:JURKOVICH, GREGORY J (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:JURKOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2221 STOCKTON BLVD., CYPRESS BLDG. 3RD FLOOR
Mailing Address - Street 2:SUITE 3111
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1418
Mailing Address - Country:US
Mailing Address - Phone:916-734-3510
Mailing Address - Fax:916-734-7089
Practice Address - Street 1:2221 STOCKTON BLVD., CYPRESS TRAUMA SURGERY CLINIC
Practice Address - Street 2:SUITE E
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1418
Practice Address - Country:US
Practice Address - Phone:916-734-3510
Practice Address - Fax:916-734-7089
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00025766208600000X, 2086S0127X, 2086S0102X
CA1410022086S0127X, 2086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
8141OtherINTERNAL ID-MOTOR VEHICLE ID
WA020027093OtherRAIL ROAD MEDICARE
WA1710063573Medicaid
WA1710063573Medicaid
WA000107189Medicare PIN
8141OtherINTERNAL ID-MOTOR VEHICLE ID