Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036.125843 | IL |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 036.125843 | IL |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | S3405 | TX |
NPI | 1831382639 |
---|---|
Provider Name | Dr. Mark Layne Jenson |
First Address | San Antonio, TX 78217-5419 |
Second Address | San Antonio, TX 78258-3924 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2007 |
Last Update Date | 20/09/2019 |