Healthcare Provider Details

I. General information

NPI: 1609072651
Provider Name (Legal Business Name): ADAM MICHAEL JENSEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S 1000 E STE 300
PAYSON UT
84651-5592
US

IV. Provider business mailing address

1055 N 500 W ATTN: CREDENTIALING
PROVO UT
84604-3305
US

V. Phone/Fax

Practice location:
  • Phone: 801-465-4481
  • Fax: 801-465-4897
Mailing address:
  • Phone: 801-354-8225
  • Fax: 801-418-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4950390-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: