Individual
ERIC D JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 W LORAIN ST, OBERLIN, OH 44074-1026
(440) 775-1211
(440) 774-5707
Mailing address
173 HOLLYWOOD ST, OBERLIN, OH 44074-1009
(440) 774-6929
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35078673
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000518261
BCBS
OH
05
—
2547793
—
OH
01
—
P00406924
RAILROAD
—
Enumeration date
10/17/2005
Last updated
12/05/2007
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