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General NPI Number Information
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NPI Number | 1134139454
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Entity Type | Individual
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Provider Name | SHAYNE RAYMOND JENSEN DPM, FACFAS
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Gender | Male
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 2201 JENKS AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-4531
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Country | US
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Telephone | 850-769-0325
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Fax | 850-769-4476
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Provider Business Mailing Address
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Address Line | 2507 HARRISON AVE UNIT 201
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City | PANAMA CITY
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State | FL
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Zip | 32405-4447
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Country | US
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Telephone | 850-769-0325
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Fax | 850-769-4476
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO2867
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO 2867
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | PO2867
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO2867
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License Number State | FL
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