Organization
KEITH D. JORGENSEN, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH D JORGENSEN MD (PRESIDENT)
(603) 432-8104
Entity
Organization
Contact information
Practice address
44 BIRCH ST, SUITE 304, DERRY, NH 03038-2752
(603) 432-8104
(603) 434-2629
Mailing address
44 BIRCH ST, SUITE 304, DERRY, NH 03038-2752
(603) 432-8104
(603) 434-2629
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
07/30/2006
Last updated
07/24/2008
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