Healthcare Provider Details

I. General information

NPI: 1871715367
Provider Name (Legal Business Name): JASON RICHARD JENSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9787 N 91ST ST STE 101
SCOTTSDALE AZ
85258-5088
US

IV. Provider business mailing address

9787 N 91ST ST STE 101
SCOTTSDALE AZ
85258-5088
US

V. Phone/Fax

Practice location:
  • Phone: 480-245-6211
  • Fax:
Mailing address:
  • Phone: 480-245-6211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMT187118
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number43504
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD29091
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR4066
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number43504
License Number StateAZ
# 6
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number43504
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: