Individual
JACK J JORGENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
604 NW RICHMOND BEACH RD, SHORELINE, WA 98177-3122
(206) 533-2900
(206) 533-2901
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
71960
WI
207Q00000X
Family Medicine Physician
Primary
MD70005153
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922503168
—
WI
05
—
2349648
—
WA
Enumeration date
03/29/2018
Last updated
02/24/2026
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