Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 0101252424 | VA |
Y | 2086S0129X | Vascular Surgeon | 081598 | GA |
NPI | 1104016443 |
---|---|
Provider Name | Dr. Todd Allan Jenkins |
First Address | Newport News, VA 23601-1318 |
Second Address | Warner Robins, GA 31093-3074 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2007 |
Last Update Date | 04/10/2018 |