Individual
JAMES E JENISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1202 W BUENA VISTA RD, STE 102, EVANSVILLE, IN 47710-5185
(812) 425-0300
(812) 428-8400
Mailing address
1202 W BUENA VISTA RD, STE 102, EVANSVILLE, IN 47710-5185
(812) 485-1220
(812) 485-8544
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01035567A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000637987
ANTHEM PIN
—
05
—
100248070A
—
IN
01
—
1578786612
GROUP NPI
—
01
—
200859330Q
MEDICAID GROUP
IN
Enumeration date
10/11/2005
Last updated
01/06/2021
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