Organization
LARRY D JENSEN DPM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY DEAN JENSEN DPM (PRESIDENT)
(503) 639-8107
Entity
Organization
Contact information
Practice address
11815 SW KING JAMES PL, SUITE 60, TIGARD, OR 97224-2478
(503) 639-8107
(503) 639-8108
Mailing address
11815 SW KING JAMES PL, SUITE 60, TIGARD, OR 97224-2478
(503) 639-8107
(503) 639-8108
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
DP00199
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500642371
—
OR
Enumeration date
11/14/2011
Last updated
05/04/2012
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