Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | F8523 | TX |
NPI | 1063467298 |
---|---|
Provider Name | Dr. Terry R Jenkins |
First Address | Bryan, TX 77802-2548 |
Second Address | Bryan, TX 77802-2548 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 08/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102870601 | (05) | TX |
116001100 | FIRST CARE PROVIDER ID (01) | TX |
830003621 | MEDICARE RAILROAD (01) | TX |
C17435 | (02) | TX |