Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | ME0083245 | FL |
NPI | 1154309607 |
---|---|
Provider Name | Dr. Frederick Jenkins |
First Address | Orlando, FL 32886-0554 |
Second Address | Jacksonville, FL 32216-4207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 23/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
62051 | BCBS (01) | FL |
H01816 | (02) | FL |