Provider Demographics
NPI:1952373425
Name:JENSEN, JOSHUA E II (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:E
Last Name:JENSEN
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:314-953-8300
Mailing Address - Fax:314-953-8333
Practice Address - Street 1:11155 DUNN RD
Practice Address - Street 2:SUITE 108N
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6150
Practice Address - Country:US
Practice Address - Phone:314-953-8300
Practice Address - Fax:314-953-8333
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2014-10-07
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Provider Licenses
StateLicense IDTaxonomies
MO36330208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200148401Medicaid
MO200148401Medicaid
MO000091534Medicare PIN
MOA11091Medicare UPIN