Doctor Name: | TYLER SCOTT JORGENSEN |
NPI Number: | 1396906335 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 145594 |
Business Practice Address: | 2401 S 31st St Temple, TX - 765080001 |
Business Phone Number: | 2547242111 |
Business Fax Number: | |
Mailing Address: | Po Box 844658, DALLAS |
State: | TX |
Postal Code: | 752844658 |
Phone Number: | 2547248800 |
Fax Number: | |
NPI Enumeration Date: | 06/23/2008 |
NPI Last Update Date: | 10/02/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 145594 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NC |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |