Individual
ALEX K JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5228 NE HOYT ST, BLDG B, 1 ST FLOOR, PORTLAND, OR 97213-3055
(503) 215-6474
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD153262
OR
2084P0800X
Psychiatry Physician
2001016822
MO
2084P0800X
Psychiatry Physician
Primary
MD153262
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500635090
—
OR
05
—
500635482
—
OR
01
—
P01238756
RR MEDICARE
OR
Enumeration date
07/05/2006
Last updated
11/29/2021
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