Healthcare Provider Details

I. General information

NPI: 1427276476
Provider Name (Legal Business Name): DAVID WILLIAM JENKINS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19555 N 59TH AVE
GLENDALE AZ
85308-6813
US

IV. Provider business mailing address

19555 N 59TH AVE
GLENDALE AZ
85308-6813
US

V. Phone/Fax

Practice location:
  • Phone: 623-572-3457
  • Fax: 623-572-3449
Mailing address:
  • Phone: 623-572-3457
  • Fax: 623-572-3449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0618
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: