Individual
DR. RANDALL D. JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 E IDAHO ST, SUITE 304, BOISE, ID 83712
(208) 381-7336
(208) 381-7029
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 706-8449
(208) 381-7029
Taxonomy
Speciality
Code
Description
License number
State
2080P0210X
Pediatric Nephrology Physician
12771
OR
2080P0210X
Pediatric Nephrology Physician
Primary
M-6953
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00340150
—
ID
05
—
270819
—
OR
05
—
8518003
—
WA
05
—
MD7720R
—
AL
05
—
XPY 190107
—
CA
Enumeration date
04/27/2006
Last updated
01/29/2016
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