Provider Demographics
NPI:1245361526
Name:BURGDORFF, JANEL (MD)
Entity type:Individual
Prefix:DR
First Name:JANEL
Middle Name:
Last Name:BURGDORFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 S WASHINGTON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-5600
Mailing Address - Country:US
Mailing Address - Phone:509-586-2828
Mailing Address - Fax:509-586-2525
Practice Address - Street 1:911 S WASHINGTON ST
Practice Address - Street 2:SUITE B
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5600
Practice Address - Country:US
Practice Address - Phone:509-586-2828
Practice Address - Fax:509-586-2525
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018641208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery