Provider Demographics
NPI:1922399534
Name:JENSON, ERIK GERBER (MD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:GERBER
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 1:2800 10TH AVE S STE 2200
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1311
Mailing Address - Country:US
Mailing Address - Phone:612-767-8370
Mailing Address - Fax:612-767-8376
Practice Address - Street 1:2800 10TH AVE S STE 2200
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1311
Practice Address - Country:US
Practice Address - Phone:612-767-8370
Practice Address - Fax:612-767-8376
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN61590207ZP0102X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI70324OtherMD LICENSE
MN61590OtherMD LICENSE