Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 4526 | AK |
NPI | 1003884321 |
---|---|
Provider Name | Loren J Jensen |
First Address | Anchorage, AK 99524-1769 |
Second Address | Anchorage, AK 99508-5231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2006 |
Last Update Date | 26/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E43394 | (02) | |
MD45261 | (05) | AK |