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Individual

DR. JACK EDWARD JENSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
9180 KATY FWY SUITE 200, HOUSTON, TX 77055-7454
(713) 984-1400
(713) 984-0544
Mailing address
9180 KATY FREEWAY, STE 200, HOUSTON, TX 77055
(713) 984-1400
(713) 647-8090

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
F1071
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
760281931
TAX IDENTIFICATION NUMBER
TX
01
82376Z
BLUE CROSS BLUE SHIELD
TX
01
F1071
TX LICENSE NUMBER
TX
Enumeration date
07/13/2005
Last updated
07/14/2016
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