Individual
DEREK RANDALL JENKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 KETTLE POINT AVE, EAST PROVIDENCE, RI 02914-5375
(401) 453-9032
(401) 861-5812
Mailing address
PO BOX 1119, PROVIDENCE, RI 02901-1119
(401) 453-9032
(401) 861-5812
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
106300
MN
207X00000X
Orthopaedic Surgery Physician
55660
MN
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
16277
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
Enumeration date
03/17/2009
Last updated
02/12/2019
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