MEDICARE: DAVID JOSEPH JENSEN D.O.

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	208100000X	Physical Medicine & Rehabilitation Physician	O-0415	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	P00744682	OTHER	ID	MCRR

General Provider Information

NPI Number	:	1407808983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID JOSEPH JENSEN D.O.

Provider Business Mailing Address
First Line	:	PO BOX 587
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83303-0587
Country	:	US
Telephone Number	:	208-814-7400
Fax Number	:	208-814-7491

Provider Business Practice Location Address
First Line	:	625 POLE LINE RD W STE 1A
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-4269
Country	:	US
Telephone Number	:	208-814-5250
Fax Number	:

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	04/18/2019

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