Provider Demographics
NPI:1164733051
Name:DAVID W. JENKINS DPM
Entity Type:Organization
Organization Name:DAVID W. JENKINS DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:480-567-0239
Mailing Address - Street 1:20165 N 67TH AVE
Mailing Address - Street 2:122-A-115
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7002
Mailing Address - Country:US
Mailing Address - Phone:480-567-0239
Mailing Address - Fax:480-567-0292
Practice Address - Street 1:9377 E BELL RD
Practice Address - Street 2:SUITE 207
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1502
Practice Address - Country:US
Practice Address - Phone:480-567-0239
Practice Address - Fax:480-567-0292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0618213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ540476Medicaid
AZ540476Medicaid