Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 200200240 | NC |
NPI | 1083605539 |
---|---|
Provider Name | Henry Avner Jenkins IV |
First Address | Skyland, NC 28776-2445 |
Second Address | Asheville, NC 28801-4104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 12/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2001937A | MEDICARE PTAN (01) | NC |
891306C | (05) | NC |
BJ4995809 | DEA (01) |