Provider Demographics
NPI:1962655803
Name:JENKINS, JOSEPH DILLON (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DILLON
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 1:1016 N VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:PORT LAVACA
Mailing Address - State:TX
Mailing Address - Zip Code:77979-3000
Mailing Address - Country:US
Mailing Address - Phone:361-552-0325
Mailing Address - Fax:361-500-6904
Practice Address - Street 1:1016 N VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-3000
Practice Address - Country:US
Practice Address - Phone:361-552-0325
Practice Address - Fax:361-500-6904
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003610A207Q00000X
TXQ4145207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine