Active NPI
Laurence G Jensen, MD
- Internal Medicine Physician
- Pueblo, CO
National Provider Identifier
1679624936
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 20991
- Practice address
- 1925 E Orman Ave
Suite A535
Pueblo, CO 81004-3537 - Phone
- (719) 564-0450
- Fax
- (719) 564-1659
- NPI assigned
- Jan 15, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 20991 | CO | Primary |
Addresses
Primary practice location
1925 E Orman Ave
Suite A535
Pueblo, CO 81004-3537
Mailing address
44 Heather CT
Pueblo, CO 81001-1057
Phone (719) 542-5349
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01209915 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20991 | CO | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209427200000",
"number": "1679624936",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "44 HEATHER CT",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810011057",
"telephone_number": "719-542-5349",
"fax_number": "719-564-1659"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1925 E ORMAN AVE",
"address_2": "SUITE A535",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810043537",
"telephone_number": "719-564-0450",
"fax_number": "719-564-1659"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENSEN",
"first_name": "LAURENCE",
"middle_name": "G",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-15",
"last_updated": "2008-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CO",
"license": "20991",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01209915",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.