Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 8017616-1204 | UT |
N | 207Q00000X | Family Doctor | R1743 | AZ |
N | 207QA0401X | Family Doctor - Addiction Medicine | 2014605 | UT |
NPI | 1316932866 |
---|---|
Provider Name | Mr. Hans C Jenkins |
First Address | Farmington, UT 84025 |
Second Address | Farmington, UT 84025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 11/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
394780 | (05) | AZ |
Z128004 | (02) |