Provider Demographics
NPI:1164463477
Name:JENSEN, JOSEPH W (DO)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:W
Last Name:JENSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 W ANTELOPE DR STE 130B
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1160
Mailing Address - Country:US
Mailing Address - Phone:801-728-9555
Mailing Address - Fax:801-728-9259
Practice Address - Street 1:1580 W ANTELOPE DR STE 130B
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1160
Practice Address - Country:US
Practice Address - Phone:017-289-5558
Practice Address - Fax:801-728-9259
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5630584-1204208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005773701Medicare PIN
UTI13669Medicare UPIN