Individual
DR. KEITH D JORGENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
44 BIRCH ST, SUITE 304, DERRY, NH 03038-2752
(603) 432-8104
Mailing address
44 BIRCH ST, SUITE 304, DERRY, NH 03038-2752
(603) 432-8104
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
7086
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30001523
—
NH
Enumeration date
02/13/2006
Last updated
03/24/2015
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