1649363763 NPI number — ROBERT P JENSEN M.D.

Table of content: ROBERT P JENSEN M.D. (NPI 1649363763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649363763 NPI number — ROBERT P JENSEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENSEN
Provider First Name:
ROBERT
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649363763
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30532
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32503-1532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-916-3700
Provider Business Mailing Address Fax Number:
850-916-8666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1040 GULF BREEZE PKWY
Provider Second Line Business Practice Location Address:
ANDREWS INSTITUTE
Provider Business Practice Location Address City Name:
GULF BREEZE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32561-7809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-916-3700
Provider Business Practice Location Address Fax Number:
850-916-8666
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME83208 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: ME83208 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 59178338 . This is a "BCBS ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 115644 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 59181065 . This is a "BCBS ALABAMA - IRC/PMR" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P00810290 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2176326 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 06010 . This is a "BCBS FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 262893700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 59185879 . This is a "BCBS ALABAMA - GBO" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 592-10093 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 7889320 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: B790 . This is a "HEALTH FIRST" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00265832 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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