MEDICARE: DR. 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	213E00000X	Podiatrist	M221	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
2	480029801	OTHER	AL	RAILROAD

General Provider Information

NPI Number	:	1831184688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY JENKINS II DPM

Provider Business Mailing Address
First Line	:	PO BOX 1412
Second Line	:
City	:	RUSSELLVILLE
State	:	AL
Zip	:	35653-3212
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	08/21/2012

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