Provider Demographics
NPI:1164620191
Name:JENSEN, SCOTT EDMUND (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:EDMUND
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 1:18890 HARBESON RD
Mailing Address - Street 2:
Mailing Address - City:HARBESON
Mailing Address - State:DE
Mailing Address - Zip Code:19951-2804
Mailing Address - Country:US
Mailing Address - Phone:718-263-4672
Mailing Address - Fax:
Practice Address - Street 1:BEEBE MEDICAL CENTER
Practice Address - Street 2:424 SAVANNAH RD
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958
Practice Address - Country:US
Practice Address - Phone:302-645-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10008261202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner