Provider Demographics
NPI:1295733285
Name:JENSEN, JACK EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:EDWARD
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9180 KATY FREEWAY
Mailing Address - Street 2:STE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055
Mailing Address - Country:US
Mailing Address - Phone:713-984-1400
Mailing Address - Fax:713-647-8090
Practice Address - Street 1:9180 KATY FWY SUITE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-7454
Practice Address - Country:US
Practice Address - Phone:713-984-1400
Practice Address - Fax:713-984-0544
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF1071207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX760281931OtherTAX IDENTIFICATION NUMBER
TX82376ZOtherBLUE CROSS BLUE SHIELD
TXF1071OtherTX LICENSE NUMBER
TX82376ZOtherBLUE CROSS BLUE SHIELD
TX760281931OtherTAX IDENTIFICATION NUMBER