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General NPI Number Information
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NPI Number | 1831184688
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Entity Type | Individual
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Provider Name | JERRY JENKINS II DPM
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Gender | Male
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 08/21/2012
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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 1412
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City | RUSSELLVILLE
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State | AL
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Zip | 35653-3212
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | M221
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License Number State | AL
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