Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS6227 | FL |
Y | 207Q00000X | Family Doctor | OS6227 | FL |
NPI | 1356325963 |
---|---|
Provider Name | Dr. Edward Brian Jorgensen |
First Address | Jay, FL 32565 |
Second Address | Jay, FL 32565 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 10/05/2016 |