Provider Demographics
NPI:1629046669
Name:JENSON, DAVID S (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:JENSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:SUITE 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
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1637213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00311622OtherRAIL ROAD INDIVIDUAL PROV. #
TX1577181-06OtherMEDICAID (HARRIS COUNTY)
TX1760605-01OtherMEDICARE DME
TX1760605-02OtherMEDICARE HOME HEALTH
TX8F2804OtherMEDICARE (MONTGOMERY COUNTY)
TX8D1689OtherMEDICARE (HARRIS COUNTY)
TX1577181-06OtherMEDICAID (HARRIS COUNTY)
TX1760605-02OtherMEDICARE HOME HEALTH