Provider Demographics
NPI:1851353965
Name:JENKO, THOMAS G (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:JENKO
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 1:8299 MT HWY 35
Mailing Address - Street 2:
Mailing Address - City:BIGFORK
Mailing Address - State:MT
Mailing Address - Zip Code:59911
Mailing Address - Country:US
Mailing Address - Phone:406-837-5541
Mailing Address - Fax:406-837-5543
Practice Address - Street 1:8299 MT HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MT
Practice Address - Zip Code:59911-3583
Practice Address - Country:US
Practice Address - Phone:406-837-5541
Practice Address - Fax:406-837-5543
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4682207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1851353965OtherBCBS
MT1851353965Medicaid
MT1851353965Medicaid