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NPI Code Detail

MEDICARE: TYLER SCOTT JORGENSEN M.D.

MEDICARE: TYLER SCOTT JORGENSEN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine PhysicianP2878TX
2390200000XStudent in an Organized Health Care Education/Training Program145594NC
3207RH0002XHospice and Palliative Medicine (Internal Medicine) PhysicianP2878TX

General Provider Information

NPI Number : 1396906335
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER SCOTT JORGENSEN M.D.
Provider Business Mailing Address
First Line : 1500 RED RIVER ST
Second Line :
City : AUSTIN
State : TX
Zip : 78701-1918
Country : US
Telephone Number : 512-324-7519
Fax Number :
Provider Business Practice Location Address
First Line : 1500 RED RIVER ST
Second Line :
City : AUSTIN
State : TX
Zip : 78701-1918
Country : US
Telephone Number : 512-324-7519
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2008
Last Update Date : 06/28/2023

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