Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0105X | Surgery of the Hand | 248277 | NY |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 248277 | NY |
NPI | 1285712323 |
---|---|
Provider Name | Christopher J Jensen |
First Address | Fairbanks, AK 99709-4873 |
Second Address | Fairbanks, AK 99709-4873 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 05/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RT 1100 | TRAINING LICENSE (01) | NH |