Individual
ALEXANDER MILES JENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(781) 301-1077
Mailing address
1103 BOGGIO DR, GALLUP, NM 87301-4906
(781) 301-1077
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
D86397
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D86397
LICENSE
MD
Enumeration date
07/30/2013
Last updated
05/12/2021
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