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NPI Code Detail

MEDICARE: DOUGLAS J JERGENSON MD

MEDICARE: DOUGLAS J JERGENSON MD
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
1207R00000XInternal Medicine Physician22254IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689678344
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS J JERGENSON MD
Provider Business Mailing Address
First Line : 221 MAIN AVE
Second Line :
City : CLINTON
State : IA
Zip : 52732-2241
Country : US
Telephone Number : 563-242-7522
Fax Number : 563-242-7534
Provider Business Practice Location Address
First Line : 221 MAIN AVE
Second Line :
City : CLINTON
State : IA
Zip : 52732-2241
Country : US
Telephone Number : 563-242-7522
Fax Number : 563-242-7534
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 10/13/2007

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Directions to “ DOUGLAS J JERGENSON MD” Practice Location

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