Provider Demographics
NPI:1821032731
Name:JENKINS, GEORGE MARK (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
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 1:221 W COLORADO BLVD
Mailing Address - Street 2:SUITE 933
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2363
Mailing Address - Country:US
Mailing Address - Phone:214-946-9898
Mailing Address - Fax:214-946-7445
Practice Address - Street 1:221 W COLORADO BLVD
Practice Address - Street 2:PAVILION II SUITE 730
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2363
Practice Address - Country:US
Practice Address - Phone:214-946-9898
Practice Address - Fax:214-946-7445
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6614207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047039504Medicaid
TX8AX680OtherBCBS
TX8DK390OtherBCBS
TX047039504Medicaid
TXTXB160485Medicare PIN
TX8AX680OtherBCBS
F64190Medicare UPIN