Provider Demographics
NPI:1427168251
Name:JENSEN, JOHN L (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:L
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1440 SO COUNTRY CLUB #30
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210
Mailing Address - Country:US
Mailing Address - Phone:480-505-0500
Mailing Address - Fax:480-644-1372
Practice Address - Street 1:1440 SO COUNTRY CLUB #30
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210
Practice Address - Country:US
Practice Address - Phone:480-505-0500
Practice Address - Fax:480-644-1372
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ13293207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11WCJBL04Medicare ID - Type Unspecified
D37085Medicare UPIN