Provider Demographics
NPI:1285799486
Name:WUCHINICH, JANE WILLIAMS (MD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:WILLIAMS
Last Name:WUCHINICH
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 1:124 HEART BUTTE ROAD
Mailing Address - Street 2:
Mailing Address - City:EAST GLACIER PARK
Mailing Address - State:MT
Mailing Address - Zip Code:59434-0350
Mailing Address - Country:US
Mailing Address - Phone:406-226-4596
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL CIRCLE DRIVE
Practice Address - Street 2:
Practice Address - City:BROWNING
Practice Address - State:MT
Practice Address - Zip Code:59417-0760
Practice Address - Country:US
Practice Address - Phone:406-338-6378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTE74042Medicare UPIN