Provider Demographics
NPI:1245280908
Name:JENNINGS, WILLIAM WESLEY III (MD)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:WESLEY
Last Name:JENNINGS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2345 E PRATER WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-9634
Mailing Address - Country:US
Mailing Address - Phone:775-356-4067
Mailing Address - Fax:702-333-8466
Practice Address - Street 1:1050 W GALLERIA DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-4800
Practice Address - Country:US
Practice Address - Phone:702-963-7000
Practice Address - Fax:702-333-8466
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO39891207V00000X
NV17694207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1245280908Medicaid
CO78328829Medicaid
WYG66482Medicare UPIN
WY1186799600Medicaid