Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 188598-1205 | UT |
NPI | 1033215686 |
---|---|
Provider Name | Dr. Peter E Jensen |
First Address | Sandy, UT 84093-6151 |
Second Address | Sandy, UT 84093-6151 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 09/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F47496 | (02) |