Provider Demographics
NPI:1326023094
Name:JURGENSEN, J CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:CRAIG
Last Name:JURGENSEN
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 1:850 WALNUT BOTTOM RD
Mailing Address - Street 2:BELVEDERE MEDICAL CORPORATION
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-3698
Mailing Address - Country:US
Mailing Address - Phone:717-243-3944
Mailing Address - Fax:717-243-7225
Practice Address - Street 1:850 WALNUT BOTTOM RD
Practice Address - Street 2:BELVEDERE MEDICAL CORPORATION
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3698
Practice Address - Country:US
Practice Address - Phone:717-243-3944
Practice Address - Fax:717-243-7225
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD013784E207R00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006563300001Medicaid
144634OtherHIGHMARK BLUE SHIELD
01634102OtherBLUE CROSS
01634102OtherBLUE CROSS
144634Medicare ID - Type Unspecified