Provider Demographics
NPI:1528162674
Name:HUGHES, JACK LINDLEY (MD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:LINDLEY
Last Name:HUGHES
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2500 N MAYFAIR RD
Mailing Address - Street 2:STE 200
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1415
Mailing Address - Country:US
Mailing Address - Phone:414-259-1930
Mailing Address - Fax:414-259-0160
Practice Address - Street 1:2500 N MAYFAIR RD
Practice Address - Street 2:STE 200
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1415
Practice Address - Country:US
Practice Address - Phone:414-259-1930
Practice Address - Fax:414-259-0160
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
WI18882020207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30938900Medicaid
WI30938900Medicaid