Basic Information
| Provider Information | |||||||||
| NPI: | 1669737250 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JENKS | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4790 COTTONVILLE RD | ||||||||
| Address2: | |||||||||
| City: | JAMESTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453351518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376752870 | ||||||||
| FaxNumber: | 9376752873 | ||||||||
| Practice Location | |||||||||
| Address1: | 4940 COTTONVILLE RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | JAMESTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453351522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376756830 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2012 | ||||||||
| LastUpdateDate: | 01/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34.011084 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.