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General NPI Number Information
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NPI Number | 1396991162
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Entity Type | Individual
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Provider Name | JASON JOSEPH JORGENSEN D.O.
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Gender | Male
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Dates
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Enumeration Date | 08/13/2008
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Last Update Date | 02/22/2021
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Provider Practice Location Address
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Address Line | 500 W MAIN ST
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City | LEWISVILLE
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State | TX
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Zip | 75057-3641
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Country | US
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Telephone | 214-970-6817
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Fax |
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Provider Business Mailing Address
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Address Line | 2637 N WASHINGTON BLVD # 164
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City | NORTH OGDEN
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State | UT
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Zip | 84414-2240
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Country | US
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Telephone | 214-970-6817
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Fax | 844-803-4513
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | N9717
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License Number State | TX
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