Provider Demographics
NPI:1134105265
Name:JURGENS, DONALD JAMES (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JAMES
Last Name:JURGENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1900 CENTRACARE CIR
Mailing Address - Street 2:CENTRACARE CLINIC HEALTH PLAZA SPECIALTIES
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-229-4907
Mailing Address - Fax:320-229-5160
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:CENTRACARE CLINIC HEALTH PLAZA SPECIALTIES
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-229-4907
Practice Address - Fax:320-229-5160
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN45752207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN590619900Medicaid
H91036Medicare UPIN
MN590619900Medicaid