Provider Demographics
NPI:1740246594
Name:JURGENSEN, KAREN SUE (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:SUE
Last Name:JURGENSEN
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 1:800 8TH AVE
Mailing Address - Street 2:STE 440
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2601
Mailing Address - Country:US
Mailing Address - Phone:817-336-6700
Mailing Address - Fax:817-336-5388
Practice Address - Street 1:800 8TH AVE
Practice Address - Street 2:STE 440
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2601
Practice Address - Country:US
Practice Address - Phone:817-336-6700
Practice Address - Fax:817-336-5388
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3006174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist