Provider Demographics
NPI:1053495614
Name:JENSEN, ALAN D (MD)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:D
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8761 WEST CENTER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2109
Mailing Address - Country:US
Mailing Address - Phone:402-397-6060
Mailing Address - Fax:402-398-0336
Practice Address - Street 1:8761 WEST CENTER RD
Practice Address - Street 2:SUITE B
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2109
Practice Address - Country:US
Practice Address - Phone:402-397-6060
Practice Address - Fax:402-398-0336
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE17820207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE274559Medicare ID - Type Unspecified
E42938Medicare UPIN