Provider Demographics
NPI:1629177027
Name:PETER J JENSEN MD PC
Entity Type:Organization
Organization Name:PETER J JENSEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-349-5275
Mailing Address - Street 1:PO BOX 897
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35631-0897
Mailing Address - Country:US
Mailing Address - Phone:256-766-5762
Mailing Address - Fax:256-740-8842
Practice Address - Street 1:2115 CLOYD BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-7512
Practice Address - Country:US
Practice Address - Phone:256-349-5275
Practice Address - Fax:256-349-5279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALA45881Medicare UPIN
AKJ851Medicare PIN