Provider Demographics
NPI:1841277662
Name:JENKINS, PHILIP ROSS (DPM)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:ROSS
Last Name:JENKINS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:401 MULBERRY ST SW STE 102
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5463
Mailing Address - Country:US
Mailing Address - Phone:828-757-6434
Mailing Address - Fax:828-757-6435
Practice Address - Street 1:401 MULBERRY ST SW STE 102
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5463
Practice Address - Country:US
Practice Address - Phone:828-757-6434
Practice Address - Fax:828-757-6435
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC401213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890803YMedicaid
NC890803YMedicaid
NC5009660004Medicare NSC
NC2433264BMedicare PIN
P00067835Medicare PIN