Provider Demographics
NPI:1316932866
Name:JENKINS, HANS C (DO)
Entity type:Individual
Prefix:MR
First Name:HANS
Middle Name:C
Last Name:JENKINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 SHEPARD LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025
Mailing Address - Country:US
Mailing Address - Phone:385-988-3965
Mailing Address - Fax:385-988-3972
Practice Address - Street 1:722 SHEPARD LN
Practice Address - Street 2:SUITE 102
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025
Practice Address - Country:US
Practice Address - Phone:385-988-3965
Practice Address - Fax:385-988-3972
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR1743207Q00000X
UT2014605207QA0401X
UT8017616-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ394780Medicaid
AZ394780Medicaid