Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | MD41046 | TN |
NPI | 1407883986 |
---|---|
Provider Name | Dr. Eric R Jensen |
First Address | Knoxville, TN 37901-5004 |
Second Address | Knoxville, TN 37916-2290 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 24/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3062658 | (05) | TN |