1629046669 NPI number — DAVID S JENSON DPM

Table of content: DAVID S JENSON DPM (NPI 1629046669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629046669 NPI number — DAVID S JENSON DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENSON
Provider First Name:
DAVID
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1629046669
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8136
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THE WOODLANDS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77387-8136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-273-6000
Provider Business Mailing Address Fax Number:
936-273-6022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 VISION PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
CONROE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77384-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-273-6000
Provider Business Practice Location Address Fax Number:
936-273-6022
Provider Enumeration Date:
03/08/2006

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: 213E00000X , with the licence number:  1637 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 1637 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00311622 . This is a "RAIL ROAD INDIVIDUAL PROV. #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1577181-06 . This is a "MEDICAID (HARRIS COUNTY)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1760605-01 . This is a "MEDICARE DME" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1760605-02 . This is a "MEDICARE HOME HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8F2804 . This is a "MEDICARE (MONTGOMERY COUNTY)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8D1689 . This is a "MEDICARE (HARRIS COUNTY)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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