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NPI Code Detail

MEDICARE: DR. CARL RYDELL JENSON MD

MEDICARE: DR. CARL RYDELL JENSON MD
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
12085R0001XRadiation Oncology Physician60780MN

General Provider Information

NPI Number : 1659317097
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CARL RYDELL JENSON MD
Provider Business Mailing Address
First Line : 1775 THOMPSON RD
Second Line :
City : COOS BAY
State : OR
Zip : 97420-2198
Country : US
Telephone Number : 541-269-8111
Fax Number : 541-269-8517
Provider Business Practice Location Address
First Line : 1775 THOMPSON RD
Second Line :
City : COOS BAY
State : OR
Zip : 97420-2198
Country : US
Telephone Number : 541-269-8111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2006
Last Update Date : 02/09/2022

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