Provider Demographics
NPI:1912115395
Name:ROUX, JENNIFER LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEIGH
Last Name:ROUX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:145 KIMEL PARK DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6984
Mailing Address - Country:US
Mailing Address - Phone:336-765-6181
Mailing Address - Fax:336-714-6481
Practice Address - Street 1:145 KIMEL PARK DR
Practice Address - Street 2:SUITE 330
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6984
Practice Address - Country:US
Practice Address - Phone:336-765-6181
Practice Address - Fax:336-714-6481
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2004-01316208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC148M5OtherBCBS
NC5909439Medicaid
NC5909439Medicaid