Healthcare Provider Details

I. General information

NPI: 1023031374
Provider Name (Legal Business Name): SUZANNE JENKINS DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 CORSICANA HWY
HILLSBORO TX
76645-2928
US

IV. Provider business mailing address

904 CORSICANA HWY
HILLSBORO TX
76645-2928
US

V. Phone/Fax

Practice location:
  • Phone: 254-582-9300
  • Fax: 254-582-9302
Mailing address:
  • Phone: 254-582-9300
  • Fax: 254-582-9302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1774
License Number StateTX

VIII. Authorized Official

Name: DR. SUZANNE RENE JENKINS
Title or Position: OWNER
Credential: DPM
Phone: 245-582-9300