Provider Demographics
NPI:1609936533
Name:JENKINS, JODY L (MD)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:L
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 COLONIA DE SALUD
Mailing Address - Street 2:STE C100
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2485
Mailing Address - Country:US
Mailing Address - Phone:520-452-0144
Mailing Address - Fax:520-452-0075
Practice Address - Street 1:75 COLONIA DE SALUD
Practice Address - Street 2:STE C100
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2485
Practice Address - Country:US
Practice Address - Phone:520-452-0144
Practice Address - Fax:520-452-0075
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ23558208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5548036OtherAETNA
AZ5548036OtherAETNA
AZG16345Medicare UPIN