Provider Demographics
NPI:1285700815
Name:JENKINS, CHARLES HART (MD)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:HART
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 1:3555 LUTHERAN PKWY
Mailing Address - Street 2:SUITE 160
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6036
Mailing Address - Country:US
Mailing Address - Phone:303-422-3727
Mailing Address - Fax:303-467-9354
Practice Address - Street 1:3555 LUTHERAN PKWY
Practice Address - Street 2:SUITE 160
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6036
Practice Address - Country:US
Practice Address - Phone:303-422-3727
Practice Address - Fax:303-467-9354
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20612207R00000X
AZ7815207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02106127Medicaid
CO02106127Medicaid
286228Medicare ID - Type Unspecified