Individual
LARRY DEAN JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
11815 SW KING JAMES PLACE, SUITE 60, TIGARD, OR 97224
(503) 639-8107
(503) 639-8108
Mailing address
11815 SW KING JAMES PLACE, SUITE 60, TIGARD, OR 97224
(503) 639-8107
(503) 639-8108
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
DP00199
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000265
—
OR
Enumeration date
08/22/2005
Last updated
05/04/2012
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