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General NPI Number Information
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NPI Number | 1922026673
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Entity Type | Individual
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Provider Name | PAUL BRIAN JUERGENS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 01/19/2016
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Provider Practice Location Address
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Address Line | 900 N WASHINGTON ST
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City | DU QUOIN
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State | IL
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Zip | 62832-1233
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Country | US
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Telephone | 573-575-6440
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Fax | 618-942-7399
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Provider Business Mailing Address
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Address Line | PO BOX 3441
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City | CARBONDALE
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State | IL
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Zip | 62902-3441
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Country | US
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Telephone | 573-575-6440
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Fax | 618-942-7399
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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 | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 036067084
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License Number State | IL
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