Provider Demographics
NPI:1508815176
Name:JENKINS, SHAWN THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:THOMAS
Last Name:JENKINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 S MAIN ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-3321
Mailing Address - Country:US
Mailing Address - Phone:830-249-9995
Mailing Address - Fax:
Practice Address - Street 1:1421 S. MAIN ST.
Practice Address - Street 2:SUITE 107
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006
Practice Address - Country:US
Practice Address - Phone:830-249-9995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3593207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181004601Medicaid
TX8G6296Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TXG28550Medicare UPIN