Healthcare Provider Details

I. General information

NPI: 1164733051
Provider Name (Legal Business Name): DAVID W. JENKINS DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 12/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9377 E BELL RD SUITE 207
SCOTTSDALE AZ
85260-1502
US

IV. Provider business mailing address

20165 N 67TH AVE 122-A-115
GLENDALE AZ
85308-7002
US

V. Phone/Fax

Practice location:
  • Phone: 480-567-0239
  • Fax: 480-567-0292
Mailing address:
  • Phone: 480-567-0239
  • Fax: 480-567-0292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0618
License Number StateAZ

VIII. Authorized Official

Name: DR. DAVID W. JENKINS
Title or Position: SOLE MEMBER
Credential: DPM
Phone: 480-567-0239