Individual
DERRICK RAY JORGENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3200 CHANNING WAY STE 206, IDAHO FALLS, ID 83404-7546
(208) 529-2230
(208) 561-8061
Mailing address
3200 CHANNING WAY STE 206, IDAHO FALLS, ID 83404-7546
(208) 716-5614
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2250
ID
Other
Enumeration date
04/14/2022
Last updated
01/28/2026
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