Provider Demographics
NPI:1730447558
Name:JENKS, CAROLYN GERHARDT (DO)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:GERHARDT
Last Name:JENKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:ANN
Other - Last Name:GERHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:501 SAUNDERS AVE STE 200
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-7524
Practice Address - Country:US
Practice Address - Phone:903-579-9800
Practice Address - Fax:903-592-5988
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO50315207R00000X
TXQ7565207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX358958201Medicaid
TXP01752687OtherRAILROAD
TXP01752687OtherRAILROAD