Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | IL | |
Y | 208600000X | Surgeon | IL |
NPI | 1013197250 |
---|---|
Provider Name | Dr. Richard Anthony Jorgensen |
First Address | Wheaton, IL 60187-4000 |
Second Address | Wheaton, IL 60187-4000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2007 |
Last Update Date | 05/11/2007 |