Individual
PHILIP D JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
425 W BANNOCK ST, BOISE, ID 83702-6035
(208) 343-6458
(208) 343-5031
Mailing address
425 W BANNOCK ST, BOISE, ID 83702-6035
(208) 343-1702
(208) 342-7042
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
M-8875
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00256600
RAILROAD MEDICARE
ID
Enumeration date
09/20/2005
Last updated
07/19/2019
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