Individual
DR. SHAYNE RAYMOND JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM, FACFAS
Contact information
Practice address
2201 JENKS AVE, PANAMA CITY, FL 32405-4531
(850) 769-0325
(850) 769-4476
Mailing address
2507 HARRISON AVE, UNIT 201, PANAMA CITY, FL 32405-4447
(850) 769-0325
(850) 769-4476
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
PO 2867
FL
213E00000X
Podiatrist
PO2867
FL
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO2867
FL
213ES0131X
Foot Surgery Podiatrist
PO2867
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
061666115
TAX ID
FL
01
—
45803
BLUECROSSBLUESHIELD GROUP
FL
01
—
480035194
RR MEDICARE
FL
01
—
65657
BLUECROSSBLUESHIEL#
FL
01
—
CK8386
RR MEDICARE GROUP
FL
Enumeration date
08/09/2006
Last updated
11/18/2020
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