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NPI Code Detail

MEDICARE: ERIC J JENKINSON MD

MEDICARE: ERIC J JENKINSON 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
12080S0010XPediatric Sports Medicine Physician01050809AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2250011958OTHERINRAIL ROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number : 1427057132
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC J JENKINSON MD
Provider Business Mailing Address
First Line : PO BOX 991950
Second Line :
City : REDDING
State : CA
Zip : 96099-1950
Country : US
Telephone Number : 530-246-2457
Fax Number : 530-246-5632
Provider Business Practice Location Address
First Line : 1255 LIBERTY ST
Second Line :
City : REDDING
State : CA
Zip : 96001-0814
Country : US
Telephone Number : 530-246-2467
Fax Number : 530-246-5632
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2005
Last Update Date : 08/03/2020

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Directions to “ ERIC J JENKINSON MD” Practice Location

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