Provider Demographics
NPI:1144339912
Name:JENSEN, WILLIAM VAN (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:VAN
Last Name:JENSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1800 N FEDERAL HWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-1034
Mailing Address - Country:US
Mailing Address - Phone:954-782-0010
Mailing Address - Fax:954-781-2139
Practice Address - Street 1:1800 N FEDERAL HWY
Practice Address - Street 2:SUITE 104
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-1034
Practice Address - Country:US
Practice Address - Phone:954-782-0010
Practice Address - Fax:954-781-2139
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 5965207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE84519Medicare UPIN
FL80472Medicare UPIN