Basic Information
| Provider Information | |||||||||
| NPI: | 1164463477 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JENSEN | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1580 W ANTELOPE DR STE 130B | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840411160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017289555 | ||||||||
| FaxNumber: | 8017289259 | ||||||||
| Practice Location | |||||||||
| Address1: | 1580 W ANTELOPE DR STE 130B | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840411160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0172895558 | ||||||||
| FaxNumber: | 8017289259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 05/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 5630584-1204 | UT | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.