Provider Demographics
NPI:1053312074
Name:JENKINS, RONALD ARMAND (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ARMAND
Last Name:JENKINS
Suffix:
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:PO BOX 51226
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-1226
Mailing Address - Country:US
Mailing Address - Phone:337-983-0700
Mailing Address - Fax:337-983-0811
Practice Address - Street 1:345 DOUCET RD
Practice Address - Street 2:SUITE 240
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3488
Practice Address - Country:US
Practice Address - Phone:337-983-0700
Practice Address - Fax:337-983-0811
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05892R173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1341843Medicaid
LA5314586OtherAETNA PROVIDER NUMBER
LA110163225OtherRR MEDICARE PROVIDER NO
LA5314586OtherAETNA PROVIDER NUMBER
LA1341843Medicaid