Provider Demographics
NPI:1477630648
Name:VICKERS, JEAN AUKERMAN (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:AUKERMAN
Last Name:VICKERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:ANN
Other - Last Name:AUKERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-0417
Mailing Address - Country:US
Mailing Address - Phone:772-223-2832
Mailing Address - Fax:772-223-5646
Practice Address - Street 1:500 SE OSCEOLA ST
Practice Address - Street 2:STE 200
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2364
Practice Address - Country:US
Practice Address - Phone:772-286-1550
Practice Address - Fax:772-221-0569
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119979207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013285300Medicaid
FL013285300Medicaid
PA2514736OtherHIGHMARK BLUE SHIELD-WMG
PA30079291OtherAMERIHEALTH MERCY-WMG
PA415289OtherUPMC-WMG
PA188900Medicare PIN
PAP00887494Medicare PIN
MD968609OtherCAREFIRST MD BCBS
PA306752OtherUNISON-WMG