Provider Demographics
NPI:1639119175
Name:JENSEN, SARAH L (MD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:L
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 HWY 61
Mailing Address - Street 2:SUITE B
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028
Mailing Address - Country:US
Mailing Address - Phone:636-933-7600
Mailing Address - Fax:636-933-5900
Practice Address - Street 1:1463 HWY 61
Practice Address - Street 2:SUITE B
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028
Practice Address - Country:US
Practice Address - Phone:636-933-7600
Practice Address - Fax:636-933-5900
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2022-01-19
Deactivation Date:2022-01-17
Deactivation Code:
Reactivation Date:2022-01-19
Provider Licenses
StateLicense IDTaxonomies
MO2006031051207N00000X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO206872806Medicaid
MO206872806Medicaid
962801696Medicare PIN
MOI68577Medicare UPIN
I68577Medicare UPIN