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General NPI Number Information
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NPI Number | 1801069752
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Entity Type | Organization
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Legal Business Name | JERRY JENKINS II DPM
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 02/04/2013
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Provider Practice Location Address
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Address Line | 533 GANDY ST NE
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City | RUSSELLVILLE
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State | AL
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Zip | 35653-1965
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Country | US
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Telephone | 256-331-3338
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Fax | 256-331-2890
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Provider Business Mailing Address
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Address Line | PO BOX 5268
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City | BELFAST
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State | ME
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Zip | 04915-5200
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Country | US
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Telephone | 256-331-3338
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Fax | 256-331-2890
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. JERRY JENKINS II
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Credential | D.P.M.
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Telephone | 256-331-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 221
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License Number State | AL
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