Provider Demographics
NPI:1235230517
Name:JENSEN, BRUCE W (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:W
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 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8001 MADISON AVE
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7901
Practice Address - Country:US
Practice Address - Phone:916-536-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC36236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C362360Medicaid
CA00C362360OtherBLUE SHIELD
CA13820OtherFIRST HEALTH
CA3170839OtherCIGNA
CA000810342990OtherPHCS
CA1089814OtherGREAT WEST
CA9525OtherINTERPLAN
CAMCMG127400OtherWESTERN HEALTH ADVANTAGE
CA4066262OtherAETNA
CAC36236OtherBLUE CROSS
CA1454451OtherUNITED HEALTHCARE
CA90014858OtherPACIFICARE
CA1454451OtherUNITED HEALTHCARE
CAC36236OtherBLUE CROSS