Provider Demographics
NPI:1871573741
Name:JENKINS, JOSEPH THOMAS (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:THOMAS
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 CEDAR CROSS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-7704
Mailing Address - Country:US
Mailing Address - Phone:563-583-8346
Mailing Address - Fax:
Practice Address - Street 1:505 CEDAR CROSS RD
Practice Address - Street 2:SUITE A
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-7704
Practice Address - Country:US
Practice Address - Phone:563-583-8346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26573208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2069948Medicaid
WI32029700Medicaid
IA15669Medicare ID - Type Unspecified
WI32029700Medicaid