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Individual

CHARLES C JENKINS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
700 RIVER DR, FORT BRAGG, CA 95437-5403
(707) 961-1234
(707) 964-3691
Mailing address
PO BOX 375, MENDOCINO, CA 95460-0375
(510) 918-5296

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
G9096
CA
208600000X
Surgery Physician
Primary
G9096
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1922031525
CA
Enumeration date
09/29/2006
Last updated
03/21/2013
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