Provider Demographics
NPI:1821476797
Name:JENSEN, BRANDON DAVID (DO)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:DAVID
Last Name:JENSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 W HORIZON RIDGE PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2722
Mailing Address - Country:US
Mailing Address - Phone:702-990-0622
Mailing Address - Fax:702-938-1473
Practice Address - Street 1:2450 W HORIZON RIDGE PKWY STE 150
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2722
Practice Address - Country:US
Practice Address - Phone:702-990-0622
Practice Address - Fax:702-938-1473
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSL1078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine