Individual
LUKE FORREST JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MHS, PA-C
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-4162
(801) 581-2121
Mailing address
30 N MARIO CAPECCHI DR. 2 SOUTH, RADIOLOGY AND IMAGING SCIENCES, SALT LAKE CITY, UT 84112
(801) 581-2967
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7777059-1206
UT
363AM0700X
Medical Physician Assistant
PA 21290
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00PA212900
BLUE SHIELD
—
Enumeration date
01/06/2011
Last updated
07/12/2024
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