Provider Demographics
NPI:1962693275
Name:JENKINS, DAVID RICHARD (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RICHARD
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 1:1008 ALABAMA AVENUE
Mailing Address - Street 2:
Mailing Address - City:DAUPHIN ISLAND
Mailing Address - State:AL
Mailing Address - Zip Code:36528
Mailing Address - Country:US
Mailing Address - Phone:251-861-3050
Mailing Address - Fax:251-861-3055
Practice Address - Street 1:1008 ALABAMA AVENUE
Practice Address - Street 2:
Practice Address - City:DAUPHIN ISLAND
Practice Address - State:AL
Practice Address - Zip Code:36528
Practice Address - Country:US
Practice Address - Phone:251-861-3050
Practice Address - Fax:251-861-3055
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13060207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51006274OtherBLUE CROSS BLUE SHIELD
ALC73525Medicare UPIN