Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DS-027565-L | PA |
Y | 213EG0000X | General Practice | DS-027565-L | PA |
NPI | 1003835828 |
---|---|
Provider Name | Dr. Carl Sees Jenkins |
First Address | Watsontown, PA 17777-1618 |
Second Address | Watsontown, PA 17777-1618 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |