Provider Demographics
NPI:1013197250
Name:JORGENSEN, RICHARD ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ANTHONY
Last Name:JORGENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 GARY CT
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4000
Mailing Address - Country:US
Mailing Address - Phone:630-710-7008
Mailing Address - Fax:
Practice Address - Street 1:1028 GARY CT
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4000
Practice Address - Country:US
Practice Address - Phone:630-710-7008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery