Basic Information
| Provider Information | |||||||||
| NPI: | 1154308112 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JENSEN | ||||||||
| FirstName: | JUDD | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 499 E HAMPDEN AVE | ||||||||
| Address2: | STE 360 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801132780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037814485 | ||||||||
| FaxNumber: | 7202740064 | ||||||||
| Practice Location | |||||||||
| Address1: | 499 E HAMPDEN AVE | ||||||||
| Address2: | STE 360 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801132780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037814485 | ||||||||
| FaxNumber: | 7202740064 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2005 | ||||||||
| LastUpdateDate: | 09/28/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 014777 | ME | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 50362 | CO | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 70528861 | 05 | CO | MEDICAID |