Provider Demographics
NPI:1437147048
Name:JENSEN, ROBERT MARK (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MARK
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1353 EAST MCANDREW ROAD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-770-6776
Mailing Address - Fax:541-770-5791
Practice Address - Street 1:1353 E MCANDREWS RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6105
Practice Address - Country:US
Practice Address - Phone:541-770-6776
Practice Address - Fax:541-770-5791
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2014-01-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD17220208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery