Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 181323-1205 | UT |
NPI | 1265957906 |
---|---|
Provider Name | Daniel Jorgensen |
First Address | Wayne, PA 19087-0418 |
Second Address | Malvern, PA 19355-1445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2017 |
Last Update Date | 03/08/2017 |