Individual
DR. ERIC L. JENISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
704 S WEBSTER AVE, SUITE 100, GREEN BAY, WI 54301-3528
(920) 433-3430
(920) 432-6313
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7210
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
038252
OH
207VX0201X
Gynecologic Oncology Physician
Primary
59856
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0288531
—
OR
05
—
1669477071
—
WI
Enumeration date
06/14/2005
Last updated
09/18/2014
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