Provider Demographics
NPI:1912941659
Name:JENKINS, BRIAN KNOX (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:KNOX
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 100833
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76185-0833
Mailing Address - Country:US
Mailing Address - Phone:817-905-9729
Mailing Address - Fax:817-378-4756
Practice Address - Street 1:1701 RIVER RUN
Practice Address - Street 2:SUITE 750
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6579
Practice Address - Country:US
Practice Address - Phone:817-905-9729
Practice Address - Fax:817-378-4756
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2664207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine