Provider Demographics
NPI:1174842363
Name:JENKINS, TRAVIS CLARKE (MD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:CLARKE
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1729 NEW HANOVER MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5345
Mailing Address - Country:US
Mailing Address - Phone:910-772-8261
Mailing Address - Fax:910-763-4608
Practice Address - Street 1:1729 NEW HANOVER MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5345
Practice Address - Country:US
Practice Address - Phone:910-772-8261
Practice Address - Fax:910-763-4608
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD452040152WC0802X
NC2015-00262207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management