MEDICARE: BRAD N JENKINS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	E2046	AR
2	207Q00000X	Family Medicine Physician	E-2046	AR
3	207P00000X	Emergency Medicine Physician	E-2046	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7824049	OTHER	AR	AETNA
2	435276	OTHER	AR	HEALTHLINK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	19145000040	OTHER	AR	QUALCHOICE

General Provider Information

NPI Number	:	1568571438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRAD N JENKINS MD

Provider Business Mailing Address
First Line	:	11001 EXECUTIVE CENTER DRIVE
Second Line	:	SUITE 200
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-4393
Country	:	US
Telephone Number	:	501-812-7800
Fax Number	:	501-812-7777

Provider Business Practice Location Address
First Line	:	2508 CRESTWOOD LANE
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7623
Country	:	US
Telephone Number	:	501-758-2294
Fax Number	:	501-758-7887

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	11/19/2014

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Directions to “ BRAD N JENKINS MD” Practice Location

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