Provider Demographics
NPI:1205985942
Name:JENNINGS, PAUL ERNEST (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ERNEST
Last Name:JENNINGS
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:PO BOX 987
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78667-0987
Mailing Address - Country:US
Mailing Address - Phone:512-353-8661
Mailing Address - Fax:
Practice Address - Street 1:1601 REDWOOD RD
Practice Address - Street 2:STE C
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-1423
Practice Address - Country:US
Practice Address - Phone:512-353-8661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8877207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG8877OtherTEXAS M.D. LICENSE
TXG8877OtherTEXAS M.D. LICENSE
E34450Medicare UPIN
TX00H62EMedicare PIN