Healthcare Provider Details

I. General information

NPI: 1659515237
Provider Name (Legal Business Name): AURORA PLASTIC SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 LATHROP ST
FAIRBANKS AK
99701-5930
US

IV. Provider business mailing address

1919 LATHROP ST SUITE 101
FAIRBANKS AK
99701-5930
US

V. Phone/Fax

Practice location:
  • Phone: 907-457-5277
  • Fax: 907-457-5278
Mailing address:
  • Phone: 907-457-5277
  • Fax: 907-457-5278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number248277
License Number StateNY

VIII. Authorized Official

Name: DR. CHRISTOPHER JONATHAN JENSEN
Title or Position: OWNER
Credential: MD
Phone: 907-457-5277