Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | J8603 | TX |
N | 207Q00000X | Family Doctor | J8603 | TX |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | J8603 | TX |
NPI | 1497783823 |
---|---|
Provider Name | Jerry H Jenkins |
First Address | Lufkin, TX 75904-0683 |
Second Address | Lufkin, TX 75904-0683 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 12/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
172791901 | (05) | TX |
G35275 | (02) | TX |