Provider Demographics
NPI:1164442117
Name:JAKINS, ALAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
Last Name:JAKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:110 W COLLEGE BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5170
Mailing Address - Country:US
Mailing Address - Phone:505-627-6849
Mailing Address - Fax:505-627-0080
Practice Address - Street 1:110 W COLLEGE BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5170
Practice Address - Country:US
Practice Address - Phone:505-627-6849
Practice Address - Fax:505-627-0080
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM86-064207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM36939Medicaid
NM36939Medicaid