Provider Demographics
NPI:1205281953
Name:CRAIG M JORGENSON MD LTD
Entity type:Organization
Organization Name:CRAIG M JORGENSON MD LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:M
Authorized Official - Last Name:JORGENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-492-7208
Mailing Address - Street 1:9975 S EASTERN AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7949
Mailing Address - Country:US
Mailing Address - Phone:702-492-7208
Mailing Address - Fax:702-616-0657
Practice Address - Street 1:9975 S EASTERN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-7949
Practice Address - Country:US
Practice Address - Phone:702-492-7208
Practice Address - Fax:702-616-0657
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRAIG M JORGENSON MD LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV207RH0002X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty