Provider Demographics
NPI:1497708408
Name:DAVID S JENSON DPM PA
Entity Type:Organization
Organization Name:DAVID S JENSON DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:JENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:936-273-6000
Mailing Address - Street 1:PO BOX 8136
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77387-8136
Mailing Address - Country:US
Mailing Address - Phone:936-273-6000
Mailing Address - Fax:936-273-6022
Practice Address - Street 1:111 VISION PARK BLVD
Practice Address - Street 2:STE. 240
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-3002
Practice Address - Country:US
Practice Address - Phone:936-273-6000
Practice Address - Fax:936-273-6022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1637213E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDE7220OtherRAIL ROAD MEDICARE GROUP #
TX0037MGOtherGROUP BCBS NUMBER
TX176060503Medicaid
TX00180YMedicare PIN
TX0037MGOtherGROUP BCBS NUMBER
TX00W419Medicare PIN