Provider Demographics
NPI:1063467298
Name:JENKINS, TERRY R (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:R
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2215 E VILLA MARIA RD
Mailing Address - Street 2:#110
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2548
Mailing Address - Country:US
Mailing Address - Phone:979-776-2000
Mailing Address - Fax:979-776-0427
Practice Address - Street 1:2215 E VILLA MARIA RD
Practice Address - Street 2:#110
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2548
Practice Address - Country:US
Practice Address - Phone:979-776-2000
Practice Address - Fax:979-776-0427
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8523207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116001100OtherFIRST CARE PROVIDER ID
TX102870601Medicaid
TX830003621OtherMEDICARE RAILROAD
TX116001100OtherFIRST CARE PROVIDER ID
TX82601BMedicare ID - Type Unspecified