MEDICARE: DR. JOSEPH THOMAS JENKINS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	200000235	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164421558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH THOMAS JENKINS MD

Provider Business Mailing Address
First Line	:	1138 N ROAD ST
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3353
Country	:	US
Telephone Number	:	252-384-2560
Fax Number	:	252-335-7836

Provider Business Practice Location Address
First Line	:	1138 N ROAD ST
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3353
Country	:	US
Telephone Number	:	252-384-2560
Fax Number	:	252-335-7836

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	12/16/2014

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