Provider Demographics
NPI:1568404689
Name:VERGAMINI, JEROME CARL (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:CARL
Last Name:VERGAMINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1047 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4913
Mailing Address - Country:US
Mailing Address - Phone:541-484-0692
Mailing Address - Fax:541-484-1605
Practice Address - Street 1:1358 OAK ST. #3
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3581
Practice Address - Country:US
Practice Address - Phone:541-686-9991
Practice Address - Fax:541-343-9441
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR091212084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry