Provider Demographics
NPI:1639242290
Name:JENKINS, ROBERT DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DOUGLAS
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5509 PLEASANT VALLEY DR
Mailing Address - Street 2:SUITE 20
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5248
Mailing Address - Country:US
Mailing Address - Phone:972-964-9600
Mailing Address - Fax:972-964-6611
Practice Address - Street 1:5509 PLEASANT VALLEY DR
Practice Address - Street 2:SUITE 20
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5248
Practice Address - Country:US
Practice Address - Phone:972-964-9600
Practice Address - Fax:972-964-6611
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK3261207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG53534Medicare UPIN