Provider Demographics
NPI:1538295910
Name:JORGENSEN, JOEL R (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:R
Last Name:JORGENSEN
Suffix:
Gender:M
Credentials:PA-C
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 4356
Mailing Address - Street 2:DEPT. 665
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4356
Mailing Address - Country:US
Mailing Address - Phone:281-440-6960
Mailing Address - Fax:281-440-6205
Practice Address - Street 1:17270 RED OAK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2632
Practice Address - Country:US
Practice Address - Phone:281-440-6960
Practice Address - Fax:281-440-6205
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA05169OtherTEXAS LICENSE
TX101051754OtherDPS
TXMJ1595719OtherDEA
TXPA05169OtherTEXAS LICENSE