Provider Demographics
NPI:1215018502
Name:JENKINS, GREGORY DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DEAN
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 221976
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91322-1976
Mailing Address - Country:US
Mailing Address - Phone:661-255-9355
Mailing Address - Fax:661-255-7591
Practice Address - Street 1:24355 LYONS AVE
Practice Address - Street 2:#130
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2300
Practice Address - Country:US
Practice Address - Phone:661-255-9440
Practice Address - Fax:661-255-7591
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40935207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29247Medicare UPIN