Provider Demographics
NPI:1588729297
Name:JORGENSEN, CHARLES RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RICHARD
Last Name:JORGENSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1615 E RIVER PKWY
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3627
Mailing Address - Country:US
Mailing Address - Phone:612-332-1140
Mailing Address - Fax:612-672-9596
Practice Address - Street 1:1615 E RIVER PKWY
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-3627
Practice Address - Country:US
Practice Address - Phone:612-332-1140
Practice Address - Fax:612-672-9596
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN16540207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease