Provider Demographics
NPI:1811092216
Name:JENSEN, CRAIG R (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:R
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 EXECUTIVE PKWY
Mailing Address - Street 2:200
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-9642
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:400 C ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84143-1005
Practice Address - Country:US
Practice Address - Phone:801-993-9582
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT84-172383-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ820896Medicaid
UT870545614JE1OtherEDUCATORS MUTUAL
UT8597445OtherWORKERS COMP
UTPRA02721OtherMOLINA
UT2090168OtherUNITED HEALTHCARE
UT107005209101OtherIHC
UT11228OtherDESERET MUTUAL
UT1502954OtherUMWA
UT546180OtherHEALTHY U
UT37794OtherPEHP
UTQM0000075886OtherALTIUS
UT11228OtherDESERET MUTUAL