Healthcare Provider Details

I. General information

NPI: 1053312074
Provider Name (Legal Business Name): RONALD ARMAND JENKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 DOUCET RD SUITE 240
LAFAYETTE LA
70503-3488
US

IV. Provider business mailing address

PO BOX 51226
LAFAYETTE LA
70505-1226
US

V. Phone/Fax

Practice location:
  • Phone: 337-983-0700
  • Fax: 337-983-0811
Mailing address:
  • Phone: 337-983-0700
  • Fax: 337-983-0811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number05892R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: