Provider Demographics
NPI:1679837785
Name:G. MARK JENKINS, MD PA
Entity Type:Organization
Organization Name:G. MARK JENKINS, MD PA
Other - Org Name:CARDIAC & VASCULAR INTERVENTIONAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-352-8838
Mailing Address - Street 1:950 SCOTLAND DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2057
Mailing Address - Country:US
Mailing Address - Phone:972-352-8838
Mailing Address - Fax:214-946-7445
Practice Address - Street 1:221 W COLORADO BLVD STE 933
Practice Address - Street 2:STE 933
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2362
Practice Address - Country:US
Practice Address - Phone:214-946-9898
Practice Address - Fax:214-946-7445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6614207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0057XZOtherBCBS
TX311312801Medicaid
TX311312801Medicaid