Provider Demographics
NPI:1043503568
Name:JENSEN, JAMES DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DANIEL
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 1:4350 LIMELIGHT AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-8034
Mailing Address - Country:US
Mailing Address - Phone:720-686-7546
Mailing Address - Fax:720-686-7544
Practice Address - Street 1:4350 LIMELIGHT AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109
Practice Address - Country:US
Practice Address - Phone:720-686-7546
Practice Address - Fax:720-686-7544
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO56422207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC528168Medicare UPIN