MEDICARE: JASON W JORGENSEN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	10528188-1206	UT

General Provider Information

NPI Number	:	1366953754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON W JORGENSEN PA-C

Provider Business Mailing Address
First Line	:	561 N 2400 W
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84601-7268
Country	:	US
Telephone Number	:	435-469-1364
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 N MAIN ST
Second Line	:
City	:	EPHRAIM
State	:	UT
Zip	:	84627-1155
Country	:	US
Telephone Number	:	435-283-4076
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2017
Last Update Date	:	10/12/2017

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