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NPI Code Detail

MEDICARE: BRIAN D JENKINS M.D.

MEDICARE: BRIAN D JENKINS 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
1207L00000XAnesthesiology Physician01040832AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11437OTHERINPHP
2000000082082OTHERINANTHEM BC/BS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891792156
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN D JENKINS M.D.
Provider Business Mailing Address
First Line : 11109 PARKVIEW PLAZA DR # 117
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11141 PARKVIEW PLAZA DR STE 200
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1714
Country : US
Telephone Number : 260-425-6030
Fax Number : 260-425-6028
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2005
Last Update Date : 10/10/2022

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Directions to “ BRIAN D JENKINS M.D.” Practice Location

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