Provider Demographics
NPI:1871554873
Name:JENSEN, JOHN MARTIN JR (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARTIN
Last Name:JENSEN
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:409 SOUTH SECOND STREET
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1786C COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17512-9508
Practice Address - Country:US
Practice Address - Phone:717-684-3663
Practice Address - Fax:717-684-9030
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2017-07-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS004334L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000100197OtherHIGHMARK BS
001531598OtherHIGHMARK BLUE SHIELD
PA0006437080004Medicaid
PA01073601OtherCAPITAL BLUE CROSS
02300000OtherCAPITAL BLUE CROSS
001531598OtherHIGHMARK BLUE SHIELD
100197Medicare ID - Type Unspecified