Provider Demographics
NPI:1396928685
Name:JENKINS, RICHARD (LMT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:JENKINS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 KENILWORTH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-2214
Mailing Address - Country:US
Mailing Address - Phone:614-251-0685
Mailing Address - Fax:
Practice Address - Street 1:3369 INDIANOLA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-4152
Practice Address - Country:US
Practice Address - Phone:614-354-1850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.012941174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist