Provider Demographics
NPI:1831184688
Name:JENKINS, JERRY II (DPM)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:
Last Name:JENKINS
Suffix:II
Gender:M
Credentials:DPM
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 1412
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-3212
Mailing Address - Country:US
Mailing Address - Phone:256-331-3338
Mailing Address - Fax:256-331-2890
Practice Address - Street 1:533 GANDY ST NE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-1965
Practice Address - Country:US
Practice Address - Phone:256-331-3338
Practice Address - Fax:256-331-2890
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALM221213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALDPM221Medicaid
AL480029801OtherRAILROAD
AL000046151Medicare PIN
U76110Medicare UPIN
ALDPM221Medicaid