Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 56422 | CO |
NPI | 1043503568 |
---|---|
Provider Name | James Daniel Jensen |
First Address | Castle Rock, CO 80109-8034 |
Second Address | Castle Rock, CO 80109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2011 |
Last Update Date | 11/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C528168 | (02) | CO |