Provider Demographics
NPI:1922166750
Name:JENSON, RONALD LEROY (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LEROY
Last Name:JENSON
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 1:2233 NORTH CENTER ROAD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603
Mailing Address - Country:US
Mailing Address - Phone:989-799-8420
Mailing Address - Fax:989-799-2251
Practice Address - Street 1:2233 NORTH CENTER ROAD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603
Practice Address - Country:US
Practice Address - Phone:989-799-8420
Practice Address - Fax:989-799-2251
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRJ030546207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0838921OtherHEALTH PLUS
37338921OtherBLUE CROSS
MI1043998Medicaid
0838921OtherHEALTH PLUS
3733892Medicare ID - Type Unspecified