Provider Demographics
NPI:1013232776
Name:JERRY L SPINKS, MD, PA
Entity Type:Organization
Organization Name:JERRY L SPINKS, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SPINKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-639-2338
Mailing Address - Street 1:410 GASLIGHT BLVD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3123
Mailing Address - Country:US
Mailing Address - Phone:936-639-2338
Mailing Address - Fax:936-639-2980
Practice Address - Street 1:410 GASLIGHT BLVD
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3123
Practice Address - Country:US
Practice Address - Phone:936-639-2338
Practice Address - Fax:936-639-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1137261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031869301Medicaid
TX031869301Medicaid