Provider Demographics
NPI:1356325963
Name:JORGENSEN, EDWARD BRIAN (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:BRIAN
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 1:14114 ALABAMA ST
Mailing Address - Street 2:JAY HOSPITAL
Mailing Address - City:JAY
Mailing Address - State:FL
Mailing Address - Zip Code:32565
Mailing Address - Country:US
Mailing Address - Phone:850-675-8035
Mailing Address - Fax:
Practice Address - Street 1:14114 ALABAMA ST
Practice Address - Street 2:JAY HOSPITAL
Practice Address - City:JAY
Practice Address - State:FL
Practice Address - Zip Code:32565
Practice Address - Country:US
Practice Address - Phone:850-675-8035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6227207Q00000X, 204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM