Healthcare Provider Details

I. General information

NPI: 1255890968
Provider Name (Legal Business Name): JASON A JERGENSEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVY MEDICINE BRANCH CLINIC-MCRD 35000 GUADAL CANAL AVE
SAN DIEGO CA
92140-0001
US

IV. Provider business mailing address

NAVAL MEDICAL CENTER SAN DIEGO 34800 BOB WILSON DRIVE
SAN DIEGO CA
92134-0001
US

V. Phone/Fax

Practice location:
  • Phone: 619-524-8484
  • Fax:
Mailing address:
  • Phone: 619-532-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102206319
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A24738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: