Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 1774 | TX |
NPI | 1033153796 |
---|---|
Provider Name | Suzanne Jenkins |
First Address | Hillsboro, TX 76645-2928 |
Second Address | Hillsboro, TX 76645-2928 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 13/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
186392001 | (05) | TX |
8W6080 | BCBS (01) | TX |
V11921 | (02) | TX |