MEDICARE: BRIAN JOSEPH JENNINGS M.D.

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	207Q00000X	Family Medicine Physician	04-41177	KS
2	207Q00000X	Family Medicine Physician	TL0005731	CO
3	207Q00000X	Family Medicine Physician	MD201060	OR

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	:	1386024800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN JOSEPH JENNINGS M.D.

Provider Business Mailing Address
First Line	:	180 FORD RD
Second Line	:
City	:	JOHN DAY
State	:	OR
Zip	:	97845-2009
Country	:	US
Telephone Number	:	541-575-0404
Fax Number	:	541-575-1124

Provider Business Practice Location Address
First Line	:	210 W 1ST ST
Second Line	:
City	:	SAINT FRANCIS
State	:	KS
Zip	:	67756-3540
Country	:	US
Telephone Number	:	785-332-2104
Fax Number	:	785-332-3255

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

Provider Enumeration Date	:	06/01/2015
Last Update Date	:	10/23/2024

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