MEDICARE: DR. SCOTT MILTON JENSEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	120685509-1205	UT
2	207Q00000X	Family Medicine Physician	20652	NV
3	207Q00000X	Family Medicine Physician	28925	AZ
4	207Q00000X	Family Medicine Physician	1348-20	WI
5	207Q00000X	Family Medicine Physician	CDR.0000986	CO

General Provider Information

NPI Number	:	1033106497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT MILTON JENSEN M.D.

Provider Business Mailing Address
First Line	:	6682 LOWER RIDGE DR
Second Line	:
City	:	LAKESIDE
State	:	AZ
Zip	:	85929-5064
Country	:	US
Telephone Number	:	928-224-4270
Fax Number	:	928-212-9017

Provider Business Practice Location Address
First Line	:	6682 LOWER RIDGE DR
Second Line	:
City	:	LAKESIDE
State	:	AZ
Zip	:	85929-5064
Country	:	US
Telephone Number	:	928-224-4270
Fax Number	:	928-212-9017

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	02/02/2026

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