Provider Demographics
NPI:1396961686
Name:JEFFREY L JENSEN DPM PC
Entity type:Organization
Organization Name:JEFFREY L JENSEN DPM PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-321-4477
Mailing Address - Street 1:4600 HALE PKWY STE 440
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4000
Mailing Address - Country:US
Mailing Address - Phone:303-321-4477
Mailing Address - Fax:303-321-5323
Practice Address - Street 1:4600 HALE PKWY STE 440
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4000
Practice Address - Country:US
Practice Address - Phone:303-321-4477
Practice Address - Fax:303-321-5323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO469213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04014197Medicaid
CO04014197Medicaid
COCA1703Medicare ID - Type UnspecifiedMEDICARE