Provider Demographics
NPI:1033215686
Name:JENSEN, PETER E (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:E
Last Name:JENSEN
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 1:7410 S CREEK RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-6151
Mailing Address - Country:US
Mailing Address - Phone:801-501-8346
Mailing Address - Fax:801-501-2627
Practice Address - Street 1:7410 S CREEK RD STE 104
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-6151
Practice Address - Country:US
Practice Address - Phone:801-501-8346
Practice Address - Fax:801-501-2627
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT188598-12052086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
005577405Medicare ID - Type Unspecified
F47496Medicare UPIN