Provider Demographics
NPI:1336153469
Name:JENSEN, JEFFERY E (DO)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:E
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 1:1055 S FORT HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3905
Mailing Address - Country:US
Mailing Address - Phone:727-447-7786
Mailing Address - Fax:727-447-5978
Practice Address - Street 1:1055 S FORT HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3905
Practice Address - Country:US
Practice Address - Phone:727-447-7786
Practice Address - Fax:727-447-5978
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5185207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD60772Medicare UPIN
FL82938YMedicare ID - Type Unspecified