Provider Demographics
NPI:1740281500
Name:JENSEN, JOSEPH DEAN (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DEAN
Last Name:JENSEN
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 1:7396 UNION PARK AVE
Mailing Address - Street 2:201
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-6700
Mailing Address - Country:US
Mailing Address - Phone:801-567-1400
Mailing Address - Fax:801-567-1777
Practice Address - Street 1:7396 UNION PARK AVE
Practice Address - Street 2:201
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-6700
Practice Address - Country:US
Practice Address - Phone:801-567-1400
Practice Address - Fax:801-567-1777
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2009-07-30
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
UT266561-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTF77800Medicare UPIN
UT000012266Medicare ID - Type Unspecified