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General NPI Number Information
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NPI Number | 1003679895
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Entity Type | Individual
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Provider Name | JAMES W JENSEN MD
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Gender | Male
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 115 BEVERLY CT
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-6205
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Country | US
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Telephone | 219-331-6117
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Fax |
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Provider Business Mailing Address
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Address Line | 12874 BELLE ISLE LN
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City | FRISCO
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State | TX
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Zip | 75033-2803
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Country | US
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Telephone | 219-331-6117
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 01024249A
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License Number State | IN
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