Healthcare Provider Details

I. General information

NPI: 1093700171
Provider Name (Legal Business Name): DAMIAN E JORGENSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 N ALBANY RD NW
ALBANY OR
97321-1433
US

IV. Provider business mailing address

444 NW ELKS DR
CORVALLIS OR
97330-3758
US

V. Phone/Fax

Practice location:
  • Phone: 541-926-3441
  • Fax:
Mailing address:
  • Phone: 541-754-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD27722
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: