Healthcare Provider Details

I. General information

NPI: 1730139890
Provider Name (Legal Business Name): WADE K. JENSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/17/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HOSPITAL LN
AFTON WY
83110-9409
US

IV. Provider business mailing address

110 HOSPITAL LN
AFTON WY
83110-9409
US

V. Phone/Fax

Practice location:
  • Phone: 307-885-5870
  • Fax:
Mailing address:
  • Phone: 307-885-5870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number7176
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number45935
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number6387824-1205
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number37741
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberM11435
License Number StateID
# 6
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number14531A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: