Provider Demographics
NPI:1043216922
Name:JORGENSEN, DOUGLAS JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JOSEPH
Last Name:JORGENSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BOWDOIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04351-3554
Mailing Address - Country:US
Mailing Address - Phone:207-622-4500
Mailing Address - Fax:207-622-5452
Practice Address - Street 1:29 BOWDOIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:ME
Practice Address - Zip Code:04351-3554
Practice Address - Country:US
Practice Address - Phone:207-622-4500
Practice Address - Fax:207-622-5452
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME 1550204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
HM197880OtherCIGNA HMO
ME041150OtherANTHEM BC/BS
G80301Medicare UPIN
MM7401Medicare ID - Type Unspecified