MEDICARE: DR. KAREN SUE JURGENSEN MD

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
1	174400000X	Specialist	G3006	TX

General Provider Information

NPI Number	:	1740246594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN SUE JURGENSEN MD

Provider Business Mailing Address
First Line	:	800 8TH AVE
Second Line	:	STE 440
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2601
Country	:	US
Telephone Number	:	817-336-6700
Fax Number	:	817-336-5388

Provider Business Practice Location Address
First Line	:	800 8TH AVE
Second Line	:	STE 440
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2601
Country	:	US
Telephone Number	:	817-336-6700
Fax Number	:	817-336-5388

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	06/24/2010

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