Provider Demographics
NPI:1831144799
Name:RONALD ARMAND JENKINS
Entity Type:Organization
Organization Name:RONALD ARMAND JENKINS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:ARMAND
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-983-0700
Mailing Address - Street 1:345 DOUCET RD
Mailing Address - Street 2:STE., 240
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3488
Mailing Address - Country:US
Mailing Address - Phone:337-983-0700
Mailing Address - Fax:
Practice Address - Street 1:345 DOUCET RD
Practice Address - Street 2:STE., 240
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3488
Practice Address - Country:US
Practice Address - Phone:337-983-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05892R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1341843Medicaid
LA1053312074OtherNPI#
LA5314586OtherAETNA
LA1053312074OtherNPI#
LA5314586OtherAETNA