Basic Information
| Provider Information | |||||||||
| NPI: | 1508815176 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JENKINS | ||||||||
| FirstName: | SHAWN | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1421 S MAIN ST | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | BOERNE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780063321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302499995 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1421 S. MAIN ST. | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | BOERNE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302499995 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 12/01/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | M3593 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 181004601 | 05 | TX | MEDICAID |