Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0117X | Orthopaedic Spine Surgeon | MD00035298 | WA |
Y | 207XS0117X | Orthopaedic Spine Surgeon | MD16763 | OR |
NPI | 1013025592 |
---|---|
Provider Name | Loren Edward Jenkins |
First Address | Clackamas, OR 97015-8970 |
Second Address | Clackamas, OR 97015-8970 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2006 |
Last Update Date | 08/07/2007 |