Provider Demographics
NPI:1851354468
Name:JENKINS, MARTIN BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:BRUCE
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7691 POPLAR AVE
Mailing Address - Street 2:PAVILLION #3213
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3904
Mailing Address - Country:US
Mailing Address - Phone:901-516-6433
Mailing Address - Fax:901-516-6632
Practice Address - Street 1:7691 POPLAR AVE
Practice Address - Street 2:PAVILLION #3213
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3904
Practice Address - Country:US
Practice Address - Phone:901-516-6433
Practice Address - Fax:901-516-6632
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2014-07-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN0158772080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB00000Medicare UPIN