Provider Demographics
NPI:1427543644
Name:JENKINS, MATTHEW DAVID (DPM)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DAVID
Last Name:JENKINS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 WESTLAND DR
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1416
Mailing Address - Country:US
Mailing Address - Phone:702-708-9510
Mailing Address - Fax:
Practice Address - Street 1:3171 US HIGHWAY 93 N
Practice Address - Street 2:STE B
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1360
Practice Address - Country:US
Practice Address - Phone:812-485-8390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-POD-LIC-94588213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery