Provider Demographics
NPI:1275574493
Name:JENSEN, PAUL L (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2310 PEGER RD
Mailing Address - Street 2:STE 106
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-5305
Mailing Address - Country:US
Mailing Address - Phone:907-456-3876
Mailing Address - Fax:907-456-3877
Practice Address - Street 1:2310 PEGER RD
Practice Address - Street 2:STE 106
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5305
Practice Address - Country:US
Practice Address - Phone:907-456-3876
Practice Address - Fax:907-456-3877
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-04-12
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Provider Licenses
StateLicense IDTaxonomies
AK5626207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD3333Medicaid
AKMD3333Medicaid