Provider Demographics
NPI:1083741961
Name:JENSEN, ROBERT WALTER (MD JD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WALTER
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:21309 W 56TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66218-9384
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 AINSWORTH DR STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1613
Practice Address - Country:US
Practice Address - Phone:928-778-0827
Practice Address - Fax:928-778-5622
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-35404207W00000X, 207YX0901X, 2084N0400X
AZ28419207WX0109X, 2084P2900X, 207YX0901X, 2084N0400X
MO20190423232084N0400X
KY283432083P0500X, 2084N0400X
FLME00663632083P0901X
OH35082933 J2084N0400X, 207YX0901X
MI43010751232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ421094Medicaid
OHG12526Medicare UPIN