Individual
MARK E JENTOFT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Mailing address
4500 SAN PABLO RD S, PROVIDER ENROLLMENT, JACKSONVILLE, FL 32224-1865
(904) 953-2150
(904) 953-0115
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
49758
MN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
ME133854
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
240002000
—
MN
05
—
35350900
—
WI
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
01
—
P01194177
RAILROAD MEDICARE
MN
Enumeration date
04/10/2007
Last updated
01/25/2024
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