Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 00009322 | AL |
NPI | 1003850678 |
---|---|
Provider Name | Dr. Elray Jenkins |
First Address | Sunrise, FL 33323-2865 |
Second Address | Enterprise, AL 36330-2510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F20876 | (02) | AL |