Individual
DR. PAUL RUSSELL JENSEN
Active
Individual
DR. PAUL RUSSELL JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
1816521205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09899
—
UT
05
—
100505791
—
NV
05
—
120827600
—
WY
05
—
807115600
—
ID
05
—
924432
—
AZ
01
—
P00205744
RAILROAD MEDICARE
UT
01
—
P00651537
RAILROAD MEDICARE
UT
Enumeration date
11/09/2005
Last updated
02/19/2019
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