MEDICARE: JERRY JENKINS II DPM

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	332B00000X	Durable Medical Equipment & Medical Supplies	221	AL

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	:	1801069752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JERRY JENKINS II DPM

Provider Business Mailing Address
First Line	:	PO BOX 5268
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-5200
Country	:	US
Telephone Number	:	256-331-3338
Fax Number	:	256-331-2890

Provider Business Practice Location Address
First Line	:	533 GANDY ST NE
Second Line	:
City	:	RUSSELLVILLE
State	:	AL
Zip	:	35653-1965
Country	:	US
Telephone Number	:	256-331-3338
Fax Number	:	256-331-2890

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	DR. JERRY JENKINS II
Credential	:	D.P.M.
Telephone Number	:	256-331-3338

Provider Enumeration Date	:	04/10/2008
Last Update Date	:	02/04/2013

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