Provider Demographics
NPI:1588634794
Name:JORGENSEN, DANIEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:JORGENSEN
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:PO BOX 1194
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-1194
Mailing Address - Country:US
Mailing Address - Phone:712-262-8120
Mailing Address - Fax:712-262-7028
Practice Address - Street 1:920 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-3641
Practice Address - Country:US
Practice Address - Phone:712-262-8120
Practice Address - Fax:712-262-7028
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21909174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7713740OtherSOUTH DAKOTA MEDICAL ASSI
MN124518OtherMINNESOTA UCARE
IA040001744OtherPALMETTO GBA RAILROAD MED
IA2005553Medicaid
IA1438OtherMIDLANDS CHOICE
IA32820OtherHEALTH PARTNERS
IA32820OtherHEALTH PARTNERS
IA20242Medicare ID - Type Unspecified