Provider Demographics
NPI:1871559682
Name:JENKINS, SCOTT (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7979 CHESSHIRE LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-2209
Mailing Address - Country:US
Mailing Address - Phone:763-420-3282
Mailing Address - Fax:763-420-3282
Practice Address - Street 1:3355 OAKDALE AVE
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55472
Practice Address - Country:US
Practice Address - Phone:763-420-3282
Practice Address - Fax:763-420-3282
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN2905129208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MND072OtherUCARE
MN31T30JEOtherBLUES
MN1300014OtherMEDICA
MN42767OtherGROUP HEALTH