Individual
DR. THEODORA E JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
650 N GIRLS SCHOOL RD, INDIANAPOLIS, IN 46214-3672
(317) 271-5080
Mailing address
PO BOX 4780, BLOOMINGTON, IN 47402-4780
(812) 336-1690
(812) 349-1311
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02001255A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02001255A
IN LICENSE
IN
01
—
02001255B
CSR
IN
Enumeration date
08/31/2006
Last updated
03/07/2023
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