# TRAVIS S JENSEN DPM PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528496411
- **Authorized official:** TRAVIS S JENSEN DPM (PROVIDER)
- **Authorized official phone:** (623) 583-2073

## Contact information

- **Practice address:** 12361 W BOLA DR, SURPRISE, AZ 85378-9021
- **Practice address phone:** (623) 584-5626
- **Mailing address:** PO BOX 1149, PEORIA, AZ 85380-1149
- **Mailing address phone:** (623) 583-2073
- **Mailing address fax:** (623) 583-1099

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | Yes |

## Other

- **Enumeration date:** 10/31/2013
- **Last updated:** 10/31/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 251822 | — | AZ |