Provider Demographics
NPI:1588646830
Name:JORGENSON, CRAIG M (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:M
Last Name:JORGENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 N GREEN VALLEY PKWY # 440-127
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-6170
Mailing Address - Country:US
Mailing Address - Phone:702-492-7208
Mailing Address - Fax:702-660-6186
Practice Address - Street 1:3830 E FLAMINGO RD # 201
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-6234
Practice Address - Country:US
Practice Address - Phone:702-659-5604
Practice Address - Fax:702-660-6186
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV9529207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1588646830Medicaid
NV101737Medicare ID - Type UnspecifiedGROUP
NV101738Medicare ID - Type UnspecifiedINDIVIDUAL
NVH24279Medicare UPIN
NVH24279Medicare UPIN