Provider Demographics
NPI:1497783823
Name:JENKINS, JERRY H (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:H
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 1:2427 FM 3258
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-0683
Mailing Address - Country:US
Mailing Address - Phone:936-676-1030
Mailing Address - Fax:936-875-5197
Practice Address - Street 1:2427 FM 3258
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-0683
Practice Address - Country:US
Practice Address - Phone:936-676-1030
Practice Address - Fax:936-875-5197
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8603207Q00000X, 207P00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172791901Medicaid
TXG35275Medicare UPIN
TXG35275Medicare UPIN