Individual
MARK RANDALL JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2015 JACKSON ST, ANDERSON, IN 46016-4337
(765) 649-2511
Mailing address
8840 COMMERCE PARK PL STE E, INDIANAPOLIS, IN 46268-3129
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01037730
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100172700
—
IN
Enumeration date
09/21/2006
Last updated
03/31/2015
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