Individual
MICHAEL G JENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC CPP
Contact information
Practice address
6585 SOUTH YALE, SUITE 1110, TULSA, OK 74136
(918) 502-7246
(918) 502-7250
Mailing address
4807 E 91ST ST, LB003, TULSA, OK 74137-2841
(918) 502-7246
(918) 502-7250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
538
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200070240A
—
OK
01
—
680535868002
BLUE CROSS BLUE SHIELD
OK
01
—
DA8285
MEDICARE RAILROAD
OK
Enumeration date
09/26/2006
Last updated
05/12/2008
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