Provider Demographics
NPI:1861728370
Name:JENSEN, ROBERT DEAN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DEAN
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2703 JAHN AVE NW
Mailing Address - Street 2:SUITE C7
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-7977
Mailing Address - Country:US
Mailing Address - Phone:253-851-2003
Mailing Address - Fax:253-851-2242
Practice Address - Street 1:2703 JAHN AVE NW
Practice Address - Street 2:SUITE C7
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-7977
Practice Address - Country:US
Practice Address - Phone:253-851-2003
Practice Address - Fax:253-851-2242
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00003045171100000X
WAMD00041822207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology