Provider Demographics
NPI:1306877535
Name:JENKINS, ALEX K (MD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:K
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MD
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 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5228 NE HOYT ST
Practice Address - Street 2:BLDG B, 1 ST FLOOR
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-3055
Practice Address - Country:US
Practice Address - Phone:503-215-6474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010168222084P0800X
ORMD153262207R00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500635090Medicaid
OR500635482Medicaid
ORP01238756OtherRR MEDICARE
ORR175669Medicare PIN
ORR175670Medicare PIN
OR500635090Medicaid
ORR175665Medicare PIN
ORR175671Medicare PIN
OR500635482Medicaid
ORR175667Medicare PIN
ORR175668Medicare PIN
ORR159651Medicare PIN