Provider Demographics
NPI:1619294337
Name:JENSEN, JESSE DAVID (DO)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:DAVID
Last Name:JENSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3465 S PIONEER PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-2076
Mailing Address - Country:US
Mailing Address - Phone:801-966-1403
Mailing Address - Fax:801-964-6478
Practice Address - Street 1:2376 N 400 E
Practice Address - Street 2:STE 203
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-3413
Practice Address - Country:US
Practice Address - Phone:801-966-1403
Practice Address - Fax:801-964-6478
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2016-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT8963761-1204207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology