Healthcare Provider Details

I. General information

NPI: 1588601397
Provider Name (Legal Business Name): ANDREW JUERGENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 CHAMBERS ST
OGDEN UT
84403-4571
US

IV. Provider business mailing address

982 CHAMBERS ST
OGDEN UT
84403-4571
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-4105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP8592
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number163834-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: