Provider Demographics
NPI:1427167675
Name:SPINKS, JERRY L
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:L
Last Name:SPINKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 GASLIGHT BLVD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3195
Mailing Address - Country:US
Mailing Address - Phone:936-639-2338
Mailing Address - Fax:936-639-2980
Practice Address - Street 1:410 GASLIGHT BLVD
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3195
Practice Address - Country:US
Practice Address - Phone:936-639-2338
Practice Address - Fax:936-639-2980
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1137207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E1137OtherLIC NUMBER
TXAJ05OtherBCBS
TXAJ05OtherBCBS
TXAJ05Medicare ID - Type Unspecified