Provider Demographics
NPI:1730139890
Name:JENSEN, WADE K (MD)
Entity type:Individual
Prefix:
First Name:WADE
Middle Name:K
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HOSPITAL LN
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:WY
Mailing Address - Zip Code:83110-9409
Mailing Address - Country:US
Mailing Address - Phone:307-885-5870
Mailing Address - Fax:
Practice Address - Street 1:110 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110-9409
Practice Address - Country:US
Practice Address - Phone:307-885-5870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD7176207X00000X
WI45935207X00000X
UT6387824-1205207X00000X
IA37741207X00000X
IDM11435207XS0117X
WY14531A207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1295480002Medicare NSC
SD1295480001Medicare NSC
IA479350004Medicare PIN
SD102592Medicare PIN