=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427276476
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID WILLIAM JENKINS DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2007
-----------------------------------------------------
Last Update Date | 07/31/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19555 N 59TH AVE
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85308-6813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-572-3457
-----------------------------------------------------
Fax | 623-572-3449
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19555 N 59TH AVE
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85308-6813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-572-3457
-----------------------------------------------------
Fax | 623-572-3449
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | 0618
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------