Healthcare Provider Details

I. General information

NPI: 1093928665
Provider Name (Legal Business Name): STEVEN ARNOLD JENISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 S SAINT FRANCIS DR RUNNELS BUILDING S1150
SANTA FE NM
87505-4173
US

IV. Provider business mailing address

513 PLAZA BALENTINE
SANTA FE NM
87501-2741
US

V. Phone/Fax

Practice location:
  • Phone: 505-476-3668
  • Fax: 505-827-0163
Mailing address:
  • Phone: 505-988-4583
  • Fax: 505-827-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number91-226
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: