Provider Demographics
NPI:1639303597
Name:JORGENSEN, TREVOR DEE (MD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:DEE
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 1:2005 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-1701
Mailing Address - Country:US
Mailing Address - Phone:503-883-8297
Mailing Address - Fax:503-836-7568
Practice Address - Street 1:2005 CEDAR ST
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-1701
Practice Address - Country:US
Practice Address - Phone:503-883-8297
Practice Address - Fax:503-836-7568
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1662032081P2900X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program