Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 20821 | NE |
NPI | 1053378406 |
---|---|
Provider Name | Dr. Ric E Jensen |
First Address | Omaha, NE 68131-2806 |
Second Address | Omaha, NE 68131-2806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 16/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0508408 | (05) | IA |
G75032 | (02) | NE |