| NPI | 1548680184 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE DAVID JENSEN Dermatologist 385-377-0212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 8963761-1204) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2021-12-21 |