Individual
TRAVIS STEVEN JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
12361 W BOLA DR, STE 100, SURPRISE, AZ 85378-9021
(623) 584-5626
(623) 584-8998
Mailing address
12361 W BOLA DR, STE 100, SURPRISE, AZ 85378-9021
(623) 584-5626
(623) 584-8998
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
16005134
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
665
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0581740001
DMERC
IL
01
—
118419
RAILROAD MEDICARE
AZ
01
—
1659366342
BC/BS
AZ
01
—
60010789
BCBS
IL
05
—
96004401
—
IL
Enumeration date
09/19/2005
Last updated
11/03/2011
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