Individual
LAURENCE G JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1925 E ORMAN AVE, SUITE A535, PUEBLO, CO 81004-3537
(719) 564-0450
(719) 564-1659
Mailing address
44 HEATHER CT, PUEBLO, CO 81001-1057
(719) 542-5349
(719) 564-1659
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20991
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01209915
—
CO
Enumeration date
01/15/2007
Last updated
04/29/2008
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