Individual
BURKITT W JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
910 E HOUSTON ST, STE 600, TYLER, TX 75702-8369
(903) 526-2644
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
P0236
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
368036501
—
TX
01
—
75-2616977-126
TRICARE
TX
01
—
8GM838
BCBS
TX
01
—
P01812738
RAIL ROAD MEDICARE
TX
Enumeration date
02/06/2007
Last updated
05/08/2017
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