Provider Demographics
NPI:1306857214
Name:JENKINS, BRIAN TOD (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:TOD
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 DEL NORTE AVE
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4125
Mailing Address - Country:US
Mailing Address - Phone:530-673-8399
Mailing Address - Fax:530-673-5339
Practice Address - Street 1:480 DEL NORTE AVE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4125
Practice Address - Country:US
Practice Address - Phone:530-673-8399
Practice Address - Fax:530-673-5339
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG040279207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A48169Medicare UPIN