Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 47280 | MA |
Y | 208200000X | Surgeon | 47280 | MA |
Y | 208600000X | Surgeon | 47280 | MA |
NPI | 1518947860 |
---|---|
Provider Name | Roger Jenkins |
First Address | Burlington, MA 01805-0001 |
Second Address | Burlington, MA 01805-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 24/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0191906 | (05) | MA |
D66164 | (02) |