Individual
DR. GREGORY R JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
300 S 3RD W, SODA SPRINGS, ID 83276-1559
(208) 547-3341
(208) 547-2790
Mailing address
300 S 3RD W, SODA SPRINGS, ID 83276-1559
(208) 547-3341
(208) 547-2790
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
O-1191
ID
207R00000X
Internal Medicine Physician
Primary
O-1191
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669533154
—
ID
05
—
1942970272
—
ID
Enumeration date
04/09/2017
Last updated
05/24/2022
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