Provider Demographics
NPI:1851617898
Name:JENSEN, PAUL THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:THOMAS
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 S RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-2097
Mailing Address - Country:US
Mailing Address - Phone:435-688-6262
Mailing Address - Fax:435-688-6263
Practice Address - Street 1:577 S RIVER RD
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2097
Practice Address - Country:US
Practice Address - Phone:435-688-6262
Practice Address - Fax:435-688-6263
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.098522207RR0500X, 2080P0216X, 2080P0204X
UT10701116-12052080P0216X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2205040Medicaid