Provider Demographics
NPI:1730141128
Name:JENKINS, JAMES MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MARK
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 1:6124 W. PARKER RD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8122
Mailing Address - Country:US
Mailing Address - Phone:972-403-1100
Mailing Address - Fax:972-403-2109
Practice Address - Street 1:6124 W. PARKER RD
Practice Address - Street 2:SUITE 330
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8122
Practice Address - Country:US
Practice Address - Phone:972-403-1100
Practice Address - Fax:972-403-2109
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9263208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175609001Medicaid
TX8D7007Medicare ID - Type Unspecified
TX8L8549Medicare PIN
TX175609001Medicaid