Provider Demographics
NPI:1285712323
Name:JENSEN, CHRISTOPHER J (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
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 1:2485 CHIEF WILLIAM DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-4873
Mailing Address - Country:US
Mailing Address - Phone:907-457-5277
Mailing Address - Fax:
Practice Address - Street 1:2485 CHIEF WILLIAM DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-4873
Practice Address - Country:US
Practice Address - Phone:907-457-5277
Practice Address - Fax:907-457-5278
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2482772086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRT 1100OtherTRAINING LICENSE