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Individual
TRAVIS STEVEN JENSEN
Active
Individual
TRAVIS STEVEN JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
16005134
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
665
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0581740001
DMERC
IL
01
—
118419
RAILROAD MEDICARE
AZ
01
—
1659366342
BC/BS
AZ
01
—
60010789
BCBS
IL
05
—
96004401
—
IL
Enumeration date
09/19/2005
Last updated
11/03/2011
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