Healthcare Provider Details

I. General information

NPI: 1205281953
Provider Name (Legal Business Name): CRAIG M JORGENSON MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9975 S EASTERN AVE SUITE 110
LAS VEGAS NV
89183-7949
US

IV. Provider business mailing address

9975 S EASTERN AVE SUITE 110
LAS VEGAS NV
89183-7949
US

V. Phone/Fax

Practice location:
  • Phone: 702-492-7208
  • Fax: 702-616-0657
Mailing address:
  • Phone: 702-492-7208
  • Fax: 702-616-0657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNV

VIII. Authorized Official

Name: CRAIG M JORGENSON
Title or Position: PHYSICIAN
Credential: MD
Phone: 702-492-7208