Provider Demographics
NPI:1881647022
Name:JORGENSON, MICHELE A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:A
Last Name:JORGENSON
Suffix:
Gender:F
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 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:
Practice Address - Street 1:8787 BRYAN DAIRY ROAD
Practice Address - Street 2:SUITE 230
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1258
Practice Address - Country:US
Practice Address - Phone:727-394-5601
Practice Address - Fax:813-635-7938
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00237982OtherRAILROAD MEDICARE
FL274339600Medicaid
I30258Medicare UPIN
FLP00237982OtherRAILROAD MEDICARE