Provider Demographics
NPI:1033287396
Name:JINKINS, WILEY J III (MD)
Entity Type:Individual
Prefix:
First Name:WILEY
Middle Name:J
Last Name:JINKINS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 N ACADEMY BLVD
Mailing Address - Street 2:SUITE 155
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1567
Mailing Address - Country:US
Mailing Address - Phone:719-219-0914
Mailing Address - Fax:719-219-0916
Practice Address - Street 1:2020 N ACADEMY BLVD
Practice Address - Street 2:SUITE 155
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1567
Practice Address - Country:US
Practice Address - Phone:719-219-0914
Practice Address - Fax:719-219-0916
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30211207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01302116Medicaid
COC17466Medicare UPIN
CO01302116Medicaid