# MICHAEL G JENSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1770684540
- **Gender:** Man
- **Credential:** PAC CPP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 538 | OK | Yes |

## Other

- **Enumeration date:** 09/26/2006
- **Last updated:** 05/12/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200070240A | — | OK |
| 01 | — | 680535868002 | BLUE CROSS BLUE SHIELD | OK |
| 01 | — | DA8285 | MEDICARE RAILROAD | OK |