Healthcare Provider Details

I. General information

NPI: 1295970309
Provider Name (Legal Business Name): ERIC RICHARD JENKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 MATLOCK RD STE 234
MANSFIELD TX
76063-6565
US

IV. Provider business mailing address

1411 N BECKLEY AVE STE 152
DALLAS TX
75203-1586
US

V. Phone/Fax

Practice location:
  • Phone: 214-948-7700
  • Fax: 214-948-7701
Mailing address:
  • Phone: 214-948-7700
  • Fax: 214-948-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberP3543
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberP3543
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: