Individual
MR. PAUL BRIAN JUERGENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
900 N WASHINGTON ST, DU QUOIN, IL 62832-1233
(573) 575-6440
(618) 942-7399
Mailing address
PO BOX 3441, CARBONDALE, IL 62902-3441
(573) 575-6440
(618) 942-7399
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
036067084
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010022254
BLUE CROSS BLUE SHIELD
IL
05
—
036067084
—
IL
01
—
CH1495
RAILROAD MEDICARE
IL
Enumeration date
07/18/2006
Last updated
01/19/2016
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