Provider Demographics
NPI:1700186137
Name:WILLIAM V JENSEN DO PA
Entity Type:Organization
Organization Name:WILLIAM V JENSEN DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-782-0010
Mailing Address - Street 1:1800 N FEDERAL HWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-1034
Mailing Address - Country:US
Mailing Address - Phone:954-782-0010
Mailing Address - Fax:954-781-2139
Practice Address - Street 1:1800 N FEDERAL HWY
Practice Address - Street 2:SUITE 104
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-1034
Practice Address - Country:US
Practice Address - Phone:954-782-0010
Practice Address - Fax:954-781-2139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty