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General NPI Number Information
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NPI Number | 1467806323
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Entity Type | Individual
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Provider Name | ANDREA JURGENS MD, MPH
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Gender | Female
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Dates
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Enumeration Date | 04/18/2016
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | 3111 AZALEA PARK DR
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City | MUSKOGEE
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State | OK
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Zip | 74401-2284
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Country | US
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Telephone | 918-608-1382
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Fax |
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Provider Business Mailing Address
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Address Line | 7300 RANCH ROAD 2222, BUILDING 1, STE 200
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City | AUSTIN
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State | TX
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Zip | 78730
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Country | US
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Telephone | 512-628-0465
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Fax |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 60929
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License Number State | TN
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