Provider Demographics
NPI:1851462998
Name:VUKY, JACQUELINE (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:VUKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 NW 22ND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2934
Mailing Address - Country:US
Mailing Address - Phone:503-299-6500
Mailing Address - Fax:503-299-6422
Practice Address - Street 1:1130 NW 22ND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2934
Practice Address - Country:US
Practice Address - Phone:503-299-6500
Practice Address - Fax:503-299-6422
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039647207RH0003X
ORMD154135207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAUS2552763OtherAETNA SPECIALIST PIN
WA110225174OtherRAILROAD MC#
WA0039582OtherLABOR AND INDUSTRIES #
AKMD0867WMedicaid
WA2341VUOtherBLUE SHIELD #
WA8284580Medicaid
ID806245600Medicaid
WAUS2552763OtherAETNA SPECIALIST PIN
WA0039582OtherLABOR AND INDUSTRIES #
WA110225174OtherRAILROAD MC#
WA2341VUOtherBLUE SHIELD #