MEDICARE: JEFFERY E JENSEN DO

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	207V00000X	Obstetrics & Gynecology Physician	OS5185	FL

General Provider Information

NPI Number	:	1336153469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY E JENSEN DO

Provider Business Mailing Address
First Line	:	1055 S FORT HARRISON AVE
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-3905
Country	:	US
Telephone Number	:	727-447-7786
Fax Number	:	727-447-5978

Provider Business Practice Location Address
First Line	:	1055 S FORT HARRISON AVE
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-3905
Country	:	US
Telephone Number	:	727-447-7786
Fax Number	:	727-447-5978

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

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Directions to “ JEFFERY E JENSEN DO” Practice Location

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