Provider Demographics
NPI:1003808650
Name:JENSEN, JENSEN L (DPM)
Entity Type:Individual
Prefix:
First Name:JENSEN
Middle Name:L
Last Name:JENSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 HALE PKWY
Mailing Address - Street 2:SUITE 440
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4000
Mailing Address - Country:US
Mailing Address - Phone:303-321-4477
Mailing Address - Fax:303-321-5323
Practice Address - Street 1:4600 HALE PKWY
Practice Address - Street 2:SUITE 440
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4000
Practice Address - Country:US
Practice Address - Phone:303-321-4477
Practice Address - Fax:303-321-5323
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO469213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01004696Medicaid
COU43147Medicare UPIN
CO01004696Medicaid