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General NPI Number Information
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NPI Number | 1659515237
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Entity Type | Organization
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Legal Business Name | AURORA PLASTIC SURGERY, LLC
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Dates
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Enumeration Date | 04/27/2009
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Last Update Date | 04/27/2009
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Provider Practice Location Address
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Address Line | 1919 LATHROP ST
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City | FAIRBANKS
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State | AK
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Zip | 99701-5930
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Country | US
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Telephone | 907-457-5277
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Fax | 907-457-5278
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Provider Business Mailing Address
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Address Line | 1919 LATHROP ST SUITE 101
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City | FAIRBANKS
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State | AK
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Zip | 99701-5930
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Country | US
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Telephone | 907-457-5277
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Fax | 907-457-5278
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHER JONATHAN JENSEN
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Credential | MD
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Telephone | 907-457-5277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 248277
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License Number State | NY
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