Provider Demographics
NPI:1184835407
Name:JENSON, PETER M (MD)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:M
Last Name:JENSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:120 CRAVEN RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4237
Mailing Address - Country:US
Mailing Address - Phone:760-291-6650
Mailing Address - Fax:760-737-3430
Practice Address - Street 1:1035 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3338
Practice Address - Country:US
Practice Address - Phone:760-728-2777
Practice Address - Fax:760-728-9732
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2024-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA92857207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABN017ZMedicare PIN