MEDICARE: BRIAN KNOX 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	207Q00000X	Family Medicine Physician	M2664	TX

General Provider Information

NPI Number	:	1912941659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN KNOX JENKINS MD

Provider Business Mailing Address
First Line	:	PO BOX 100833
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76185-0833
Country	:	US
Telephone Number	:	817-905-9729
Fax Number	:	817-378-4756

Provider Business Practice Location Address
First Line	:	1701 RIVER RUN
Second Line	:	SUITE 750
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6579
Country	:	US
Telephone Number	:	817-905-9729
Fax Number	:	817-378-4756

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	06/06/2013

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