Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 10701116-1205 | UT |
N | 207RR0500X | Rheumatology | 35.098522 | OH |
N | 2080P0216X | Pediatric Rheumatologist | 10701116-1205 | UT |
N | 2080P0216X | Pediatric Rheumatologist | 35.098522 | OH |
NPI | 1851617898 |
---|---|
Provider Name | Paul Thomas Jensen |
First Address | St George, UT 84770-3705 |
Second Address | St George, UT 84770-3705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2010 |
Last Update Date | 07/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2205040 | (05) | OH |