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General NPI Number Information
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NPI Number | 1093991861
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Entity Type | Organization
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Legal Business Name | THOMAS JOSEPH JENNINGS MD
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Dates
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Enumeration Date | 01/11/2008
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | 2824 S STATE ST
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-2478
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Country | US
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Telephone | 269-982-4020
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Fax | 269-982-4017
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Provider Business Mailing Address
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Address Line | 2824 S STATE ST
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-2478
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Country | US
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Telephone | 269-982-4020
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Fax | 269-982-4017
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. THOMAS J JENNINGS
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Credential | M.D
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Telephone | 269-982-4020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 4301055947
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License Number State | MI
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