Provider Demographics
NPI:1760517536
Name:QUISTGAARD, .JORGEN (MD)
Entity Type:Individual
Prefix:DR
First Name:.JORGEN
Middle Name:
Last Name:QUISTGAARD
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 1:715 S ALDER ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-6615
Mailing Address - Country:US
Mailing Address - Phone:360-452-8324
Mailing Address - Fax:
Practice Address - Street 1:715 S ALDER ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6615
Practice Address - Country:US
Practice Address - Phone:360-452-8324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA8390207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8390OtherLICENSE