Individual
DR. JOHN L JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
621 MEMORIAL DR, STE 502, SOUTH BEND, IN 46601-1075
(574) 234-9001
(574) 287-5367
Mailing address
621 MEMORIAL DR, STE 502, SOUTH BEND, IN 46601-1075
(574) 234-9001
(574) 287-5367
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
01025732
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100325320A
—
IN
Enumeration date
06/01/2005
Last updated
10/06/2010
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