Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QS0010X | Family Doctor - Sports Medicine | 1487 | TN |
Y | 207QS0010X | Family Doctor - Sports Medicine | 35705 | SC |
NPI | 1104812874 |
---|---|
Provider Name | David M. Jenkinson |
First Address | Charlotte, NC 28289-6239 |
Second Address | Swansea, SC 29160-8665 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 06/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
357055 | (05) | SC |
F83213 | (02) |