Provider Demographics
NPI:1316029473
Name:JORGENSEN, MARIA J (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:J
Last Name:JORGENSEN
Suffix:
Gender:F
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:PO BOX 565
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-0565
Mailing Address - Country:US
Mailing Address - Phone:509-853-4327
Mailing Address - Fax:509-853-4333
Practice Address - Street 1:1300 N 1ST ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-1702
Practice Address - Country:US
Practice Address - Phone:509-853-4327
Practice Address - Fax:509-853-4333
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028799207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8178584Medicaid
WA8178584Medicaid
WAG14446Medicare UPIN